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@PHDTHESIS{vonHarten:480235,
author = {von Harten, Ronja},
othercontributors = {Pape, Hans-Christoph and Pufe, Thomas},
title = {{D}ie ventrale {S}chulterluxation : {A}ssoziation zwischen
{B}ankart-{L}äsion und {H}ill-{S}achs-{D}elle},
school = {Aachen, Techn. Hochsch.},
type = {Dissertation},
address = {Aachen},
publisher = {Publikationsserver der RWTH Aachen University},
reportid = {RWTH-2015-03518},
pages = {VIII, 96 S. : Ill., graph. Darst.},
year = {2015},
note = {Aachen, Techn. Hochsch., Diss., 2015},
abstract = {Background: The glenohumeral joint has the highest range of
motion but also the highest rate of luxation in the human
body. Shoulder luxations are typically anterior luxations
which result from a fall onto the externally rotated and
abducted arm. Separation of the humeral head and glenoid
causes typical injuries on both elements of the glenohumeral
joint: a cartilaginous or bony detachment of the glenoid rim
(Bankart lesion) and a compression fracture of the humeral
head (Hill-Sachs lesion). Bankart lesions are diagnosed in
47 - 80 $\%$ of all shoulders after luxation [Griffith et
al. 2008, Tylor and Aciero 1997]. Hill-Sachs-lesions appear
in 47 - 80 $\%$ of all shoulders after dislocation and in up
to 100 $\%$ after recurrent dislocation [Bushnell et al.
2008b]. The aim of this study is to quantify the association
between existence of both lesions after anterior shoulder
dislocation and investigate an association between sizes of
both lesions. Materials and Methods: The collective
consisted of patients who were treated with shoulder
luxation (S43.0) at the UKA between 2006 and 2013. Inclusion
criteria were anterior luxation, presence of MRI-images of
the affected shoulder and absence of other injuries or
former operations of the shoulder. Bankart lesions were
classified as labral or bony lesions. Hill-Sachs lesions
were measured on axial images and classified with the help
of a modified classification by Calandra et al. into grades
I - III [Calandra et al. 1989]. The software SAS®, Version
9.2 was used for statistical analysis. Results: 105 patients
with 110 affected shoulders were enclosed in this study (85
male, 20 female patients) with an age of 35,6 ± 16,5 (16 -
80) years. 77 shoulders had experienced primary
dislocations, 33 recurrent dislocations. Bankart lesions
were identified in 73 $\%$ of all shoulders, with 71 $\%$
being cartilaginous lesions and 29 $\%$ being bony lesions.
Hill-Sachs lesions were diagnosed in 82 $\%$ of all
shoulders with 27 $\%$ affecting only the articular surface
of the humeral head (grade I), 66 $\%$ being small
subchondral lesions (grade II) and 7 $\%$ being large
subchondral defects. Hill-Sachs lesions had a size of 4,3 ±
3,2 (0 - 15,1) mm in depth and 13,1 ± 4,0 (5,6 - 29,7) mm
in width. In 75 shoulders both lesions where found, while 13
showed no lesion. In 17 shoulders isolated Hill-Sachs
lesions where diagnosed and in 5 shoulders isolated Bankart
lesions. These findings resulted in an odds ratio of 11,47
$(95\%$ KI 3,60 - 36,52, p $\<$ 0,001) for the concomitance
of both lesions. A correlation between the type of Bankart
lesion (labral or bony) and the size of Hill-Sachs lesion
(grade I - III) was proven (Spearman correlation coefficient
0,34, $95\%$ KI 0,16 - 0,49, p $\<$ 0,001). Logistic
regression showed an association between the existence of
Bankart lesions and the depths of concomitant Hill-Sachs
lesions (OR = 1,24, $95\%$ KI 1,02 - 1,52, p = 0,033). The
width of Hill-Sachs lesions was not associated with the
existence of Bankart lesions. Hill-Sachs lesions in
shoulders with bony Bankart lesions were significantly
deeper and wider than in shoulders with labral lesions (p
$\<$ 0,001). Conclusion: If either a Bankart lesion or a
Hill-Sachs lesion is diagnosed in a shoulder after anterior
luxation, it is approximately 11 times more likely to find
the second type of lesion than an isolated lesion. There is
a positive correlation between the sizes of Bankart and
Hill-Sachs lesions. In the last years it has become apparent
that Bankart as well as Hill-Sachs lesions have to be
considered for the planning of operative treatment of
anterior shoulder dislocation. It is of great importance to
evaluate both lesions together as bipolar injuries. To this
end exact diagnostics of both lesions are needed. The
findings of this study can help to improve diagnostics of
Bankart and Hill-Sachs lesions in MRI. We would like to draw
attention on the association of Bankart lesion and
Hill-Sachs lesion and to point out the importance of
considering both lesions in treatment planning.},
cin = {533500-3 ; 931510 / 511001-5},
ddc = {610},
cid = {$I:(DE-82)533500-3_20140620$ /
$I:(DE-82)511001-5_20140620$},
typ = {PUB:(DE-HGF)11},
urn = {urn:nbn:de:hbz:82-rwth-2015-035186},
url = {https://publications.rwth-aachen.de/record/480235},
}
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