Combined Hill-Sachs remplissage and Latarjet procedure: does glenoid track help decision making?

We aim to analyze recurrence of dislocation after Latarjet bone block with or without Hill-Sachs Remplissage (HSR) to specify the indication of a combined procedure.

We analyzed 118 patients with a bipolar lesions and a minimum follow-up of 2 years. All procedures were performed arthroscopically by 3 surgeons in on center. Preoperative and postoperative computed tomography (CT) scans were collected. We also collected preoperative and postoperative clinical scores Two groups were identified: 30 patients with arthroscopic Latarjet bone block combined with a HSR (group I) and 88 patients with an isolated Latarjet (group II). Measurements were performed on a reformatted shoulder CT-scan. On preoperative CT-scans, we measured the glenoid bone loss, the width and the length of the humeral lesion then the glenoid track and Hill-Sachs interval.

The mean follow-up is 6 years. Five dislocations occurred in group II, none in group I. The area of glenoid bone loss was higher in group I than in group II (33.4% ± 4.5% vs. 20.5% ± 8.9%, P = .001). Twenty shoulders presented an Off-Track lesion preoperatively that was always compensated postoperatively by the bone block in group I. No cutoff was found to be discriminating enough to help in the decision-making process. All recurrences had an Instability Severity Index score > 6.

No recurrence occurred in Group I. However, 5 patients (6%) in Group II experienced a recurrent dislocation with no significant difference. Glenoid track is not an isolated argument to indicate an isolated bone block procedure or a combined HSR. The risk of recurrence increases in patients with an Instability Severity Index score over 6 and in this case, a combine procedure should be recommended.