Hill-Sachs Lesion on MR Arthrography of the Shoulder: Relationship with Bankart Lesion on Arthroscopy and Frequency of Shoulder Dislocations

견관절자기공명관절조영술에서의 Hill-Sachs병변과 관절경에서의 Bankart병변, 견관절탈구빈도와의 상관성

  • Kim, Ji Na (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Min Hee (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Ahn, Joong Mo (Department of Radiology, University of Pittsburgh Medical Center)
  • 김지나 (성균관의대 강북삼성병원 영상의학과) ;
  • 이민희 (성균관의대 강북삼성병원 영상의학과) ;
  • 안중모 (미국 피츠버그대학병원 영상의학과)
  • Received : 2013.01.04
  • Accepted : 2013.03.13
  • Published : 2013.04.30

Abstract

Purpose : This study was performed to evaluate the presence and severity of Hill-Sachs (HS) lesions on MR arthrography (MRA) of shoulder in patients with Bankart lesions following anterior dislocation and to investigate their relationship with Bankart lesions and frequency of dislocations. Materials and Methods: 86 MRA of shoulder were evaluated in patients with arthroscopic Bankart repairs following anterior dislocations. The largest surface length of HS lesion on MRA and extent of Bankart lesions on arthroscopy were measured. Relationships between length of HS lesions and extent of Bankart lesions and frequency of dislocations were assessed. Results: HS lesions were identified on MRA in 78 patients. The largest surface length of HS lesion ranged from 9.3 mm to 29.6 mm (mean, 18.8 mm). The extent of Bankart lesion ranged from one to six o'clock extent (mean, 4.25 o'clock extent). Three patients had single dislocation and the other 75 patients had recurrent dislocations (mean 24.5 times). The largest surface length of HS lesions was positively correlated with extent of Bankart lesions (p = 0.001, r = 0.37), but not with frequency of dislocation. Conclusion: HS lesion was very common in patients with Bankart lesion. The severity of HS lesions was correlated with extent of Bankart lesions.

목적: 견관절 전방탈구 후 Bankart 병변이 있었던 환자의 자기공명관절조영술 (MRA)에서 Hill-Sachs (HS) 병변의 유무와 정도를 평가하고, 이를 관절경에서 보인 Bankart 병변의 크기와 탈구 빈도와 비교하고자 하였다. 대상과 방법: 견관절 전방탈구 후 발생한 Bankart 병변의 관절경 수술을 시행 받은 86명의 MRA를 분석하였다. MRA에서 HS 병변의 가장 큰 표면길이와, 관절경에서 보인 Bankart 병변의 크기를 측정하였다. HS 병변 길이와 Bankart 병변 크기, 탈구 빈도 사이의 상관성을 분석하였다. 결과: HS 병변은 78명에서 관찰되었다. HS 병변의 가장 긴 표면길이는 평균 18.8 mm (9.3 - 29.6 mm) 였고, Bankart 병변은 평균 4.25시계구간 크기 (1-6시계구간 크기) 였다. 3명은 단일탈구, 75명은 재발탈구였다. HS 병변의 크기는 Bankart 병변의 크기와 유의한 양의 상관관계를 보였고 (p = 0.001, r = 0.37), 탈구 빈도와는 관련성이 없었다. 결론: HS 병변은 Bankart 병변이 있는 환자에서 흔하게 발견되었다. HS 병변과 Bankart 병변의 크기와 유의한 양의 상관관계를 보였다.

Keywords

References

  1. Bankart A. The pathology and treatment of recurrent anterior dislocation of the shoulder joint. Br J Surg 1938;26:23-29 https://doi.org/10.1002/bjs.18002610104
  2. Hill H, Sachs M. The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the sholuder. Radiology 1940;35:690-700 https://doi.org/10.1148/35.6.690
  3. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 1989;5:254-257 https://doi.org/10.1016/0749-8063(89)90138-2
  4. Beltran J, Rosenberg ZS, Chandnani VP, Cuomo F, Beltran S, Rokito A. Glenohumeral instability: evaluation with MR arthrography. Radiographics 1997;17:657-673 https://doi.org/10.1148/radiographics.17.3.9153704
  5. Workman TL, Burkhard TK, Resnick D, et al. Hill-Sachs lesion: comparison of detection with MR imaging, radiography, and arthroscopy. Radiology 1992;185:847-852 https://doi.org/10.1148/radiology.185.3.1438774
  6. Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003;180:1423-1430 https://doi.org/10.2214/ajr.180.5.1801423
  7. Antonio GE, Griffith JF, Yu AB, Yung PS, Chan KM, Ahuja AT. First-time shoulder dislocation: high prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging 2007;26:983-991 https://doi.org/10.1002/jmri.21092
  8. Widjaja AB, Tran A, Bailey M, Proper S. Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation. ANZ J Surg 2006;76:436-438 https://doi.org/10.1111/j.1445-2197.2006.03760.x
  9. Griffith JF, Antonio GE, Yung PS, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol 2008;190:1247-1254 https://doi.org/10.2214/AJR.07.3009
  10. Spatschil A, Landsiedl F, Anderl W, et al. Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 2006;126: 217-222 https://doi.org/10.1007/s00402-005-0006-4
  11. Cetik O, Uslu M, Ozsar BK. The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation. Acta Orthop Belg 2007;73:175-178
  12. Griffith JF, Yung PS, Antonio GE, Tsang PH, Ahuja AT, Chan KM. CT compared with arthroscopy in quantifying glenoid bone loss. AJR Am J Roentgenol 2007;189:1490-1493 https://doi.org/10.2214/AJR.07.2473
  13. Cicak N, Bilic′R, Delimar D. Hill-Sachs lesion in recurrent shoulder dislocation: sonographic detection. J Ultrasound Med 1998;17:557-560 https://doi.org/10.7863/jum.1998.17.9.557
  14. Omoumi P, Teixeira P, Lecouvet F, Chung CB. Glenohumeral joint instability. J Magn Reson Imaging 2011;33:2-16 https://doi.org/10.1002/jmri.22343
  15. Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy 2008;24:1061-1073 https://doi.org/10.1016/j.arthro.2008.05.015
  16. Burkart AC, Debski RE. Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 2002;400:32-39 https://doi.org/10.1097/00003086-200207000-00005
  17. Sanders TG, Morrison WB, Miller MD. Imaging techniques for the evaluation of glenohumeral instability. Am J Sports Med 2000;28:414-434
  18. Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005;237:578-583 https://doi.org/10.1148/radiol.2372041429
  19. Oh JH, Kim JY, Choi JA, Kim WS. Effectiveness of multidetector computed tomography arthrography for the diagnosis of shoulder pathology: comparison with magnetic resonance imaging with arthroscopic correlation. J Shoulder Elbow Surg 2010;19:14-20 https://doi.org/10.1016/j.jse.2009.04.012
  20. Singson RD, Feldman F, Bigliani L. CT arthrographic patterns in recurrent glenohumeral instability. AJR Am J Roentgenol 1987;149:749-753 https://doi.org/10.2214/ajr.149.4.749
  21. Cook JV, Tayar R. Double-contrast computed tomographic arthrography of the shoulder joint. Br J Radiol 1989;62:1043- 1049 https://doi.org/10.1259/0007-1285-62-744-1043
  22. Ito H, Takayama A, Shirai Y. Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2000;9:495-497 https://doi.org/10.1067/mse.2000.106920
  23. Bigliani L, Flatow E, Pollock R. Rockwood and Green's fractures in adults, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2005