Editorial Commentary: Does Size Matter? Evaluating Hill-Sachs Lesion Size in Shoulder Instability

Does the size of a Hill-Sachs lesion (HSL) matter? Since its original description in 1940, understanding of the HSL's contribution to recurrent shoulder instability has evolved from a binary engaging/nonengaging framework under the glenoid track concept to more nuanced concepts of bipolar bone loss on a continuum. Although much attention has been centered on glenoid bone loss, the contribution of an HSL and, perhaps more importantly, the distance to dislocation of the HSL have gained increasing attention. How to evaluate at-risk patients with chronic shoulder instability and multiple, recurrent instability events remains problematic, especially when their shoulder fits a classic on-track, nonengaging biomechanical profile. Do patients with chronic and recurrent instability events have worse, larger, or more medialized HSL? Should we do more than isolated arthroscopic Bankart repair in these patients? The paradigm appears to shift along with the location of the HSL.