Measurement of the Hill-Sachs lesion (HSL) has been an area of interest for clinicians as quantification of bone loss is crucial in treatment decisions for patients with shoulder instability. Currently, there no consensus on a widely accepted measurement technique for calculating HSLs. The purpose of this scoping review is to provide an overview of the techniques and imaging modalities to assess the Hill-Sachs lesion pre-operatively.
Four online databases (PubMed, Embase, MEDLINE and COCHRANE) were searched for literature on the various modalities and measurement techniques used for quantifying the Hill-Sachs lesion, from data inception to October 1, 2020. The Methodological Index for Non-Randomized Studies tool was used to assess study quality. Data are presented descriptively.
Overall, 42 studies encompassing 2899 patients were included in this review. The distribution of index tests used was Magnetic Resonance Arthrography (MRA) (26%), Magnetic Resonance Imaging (MRI) (25%), 3D-Computed Tomography (13%), Computed Tomography (CT) (11%), Computerized Arthrotomography (CTA) (9%), ultrasound (9%), radiography (4%), 3D Magnetic Resonance (2%) as an index test. MRA and MRI showed the highest sensitivity, specificity, and accuracy values. Intrarater and interrater agreement was shown to be the highest amongst MRA. The most common reference tests for measuring the Hill-Sachs lesion were arthroscopy, radiography, arthro-CT, and surgical techniques.
MRA and MRI are reliable imaging modalities with good test diagnostic properties for assessment of HSLs. There is a wide variety of measurement techniques and imaging modalities for HSL assessment however a lack of comparative studies exists. Thus, is not possible to comment on the superiority of one technique over another. Future studies comparing imaging modalities and measurement techniques are needed that incorporate a cost benefit analysis.