Itoi's 2017 narrative review explains the biomechanical basis for evaluating bone loss in anterior shoulder instability and introduces the on-track/off-track framework for determining whether a Hill-Sachs lesion will engage the glenoid rim after Bankart repair — and what to do about it.
When you see a patient with recurrent anterior shoulder instability, obtain 3D CT of both shoulders and calculate the glenoid track (0.83D − d): if the Hill-Sachs lesion's medial margin exceeds that width, it's off-track and Bankart repair alone carries a ~75% recurrence risk — add remplissage or plan a Latarjet.
Itoi's 2017 narrative review explains the biomechanical basis for evaluating bone loss in anterior shoulder instability and introduces the on-track/off-track framework for determining whether a Hill-Sachs lesion will engage the glenoid rim after Bankart repair — and what to do about it.
When you see a patient with recurrent anterior shoulder instability, obtain 3D CT of both shoulders and calculate the glenoid track (0.83D − d): if the Hill-Sachs lesion's medial margin exceeds that width, it's off-track and Bankart repair alone carries a ~75% recurrence risk — add remplissage or plan a Latarjet.