MRI Right Shoulder - Report Summary

Key MRI Findings:

1. Hill-Sachs Lesion - Flattening of the posterolateral margin of the humeral head (1.5 cm length, 4 mm depth) with T2/PDFS hyperintensity - a classic sign of prior shoulder dislocation.
2. Bankart Lesion - Tear of the anteroinferior glenoid labrum from 3 to 6 o'clock, with complete tearing and stripping of the periosteum - consistent with anterior shoulder instability.
3. Grade I Acromioclavicular (AC) Joint Injury - T2/PD-FS hyperintense signal in the AC joint.
4. Supraspinatus Tendinopathy - Critical zone thickening with intratendinous T2/PD-FS hyperintensity, without fiber discontinuity (no full tear).
5. Bicipital Tenosynovitis - Fluid in the bicipital groove around the long head of biceps tendon; no tendon tear.
6. Subacromial-Subdeltoid Bursitis - Mild fluid in the bursa.
7. Additional findings: Fluid in subscapular recess and axillary recess; shoulder joint space, infraspinatus, and surrounding soft tissues appear normal.

Impression (Diagnoses):

• Hill-Sachs lesion at posterolateral margin of humeral head
• Bankart lesion of anteroinferior glenoid labrum
• Grade I injury of acromioclavicular joint
• Supraspinatus tendinopathy at critical zone
• Bicipital tenosynovitis
• Subacromial-subdeltoid bursitis

Treatment Options for Hill-Sachs and Bankart Lesions

Step 1: Non-Operative Management

• Immobilization (sling) for 2-4 weeks, followed by physiotherapy
• Rotator cuff and periscapular muscle strengthening
• Proprioceptive neuromuscular training
• Limitation: High recurrence rates in young, active males (>70% without surgery) - Rockwood & Green's Fractures in Adults 10th Ed, p. 1277

Step 2: Surgical Treatment Decision Algorithm

• < 13.5% loss in high-risk patients (young, male, contact sport) → Arthroscopic Bankart Repair
• 13.5-17.3% → Gray zone; consider bone procedure in high-risk patients

• 17.3-25% → Latarjet procedure preferred

• 40% → Eden-Hybinette procedure (structural bone graft)

• Small/non-engaging → Bankart repair alone may suffice
• 20-30% defect → Remplissage + Bankart repair
• ≥ 40% defect → Allograft reconstruction (humeral head or talus allograft)

Surgical Options in Detail

1. Arthroscopic Bankart Repair (ABR) - PRIMARY choice for most patients

• Now accounts for ~90% of all shoulder stabilization procedures
• Reattaches the torn anteroinferior labrum to the glenoid rim using suture anchors
• Recurrence rates similar to open surgery when patient selection is appropriate
• Advantages: Less subscapularis morbidity, faster recovery, better range of motion preservation vs. open
• Key limitation: Less effective when significant bone loss is present
• Rockwood & Green's, p. 1276

2. Open (Classic) Bankart Repair

• Previously the gold standard; recurrence rates < 10%
• More secure repair and better capsular tensioning
• Disadvantage: Restricts external rotation, risk of secondary arthritis, subscapularis muscle disruption
• Still preferred in revision cases or complex instability with capsular deficiency

3. Remplissage Procedure (for Hill-Sachs lesions)

• Arthroscopic technique: infraspinatus tendon and posterior capsule are filled into the Hill-Sachs defect using suture anchors
• Converts the engaging Hill-Sachs defect into an extra-articular lesion, preventing it from "locking" onto the glenoid rim
• Indications: Hill-Sachs lesion ≥ 25% depth (≥ 6 mm), or any significant defect in contact/collision athletes
• Performed simultaneously with arthroscopic Bankart repair
• Latest evidence (2025 meta-analysis, PMID 38742747): Adding remplissage to Bankart repair significantly reduces redislocation rates in patients with an engaging Hill-Sachs defect
• A 2025 systematic review (PMID 40990567) confirmed low recurrent instability rates AND no significant reduction in range of motion at 5-year follow-up
• A 2024 meta-analysis (PMID 38499236) showed higher return-to-sport and lower revision rates with Bankart + remplissage vs. Bankart alone

4. Latarjet Procedure (Coracoid Transfer)

• The coracoid process (with attached conjoined tendon) is transferred to the anterior glenoid rim
• Triple mechanism: (a) bony augmentation of the glenoid, (b) sling effect of conjoined tendon, (c) capsular reinforcement
• Indications: Glenoid bone loss > 25%, failed prior Bankart repair, high-demand contact athletes
• Can be combined with remplissage for moderate Hill-Sachs (20-30%) lesions
• Campbell's Operative Orthopaedics 15th Ed 2026, p. 5140

5. Eden-Hybinette Procedure

• Free bone block (iliac crest autograft or allograft) placed on anterior glenoid rim
• For large glenoid defects > 40% where Latarjet is insufficient

6. Humeral Head Allograft Reconstruction

• For very large Hill-Sachs defects (≥ 40%), the defect is filled with humeral head or talus allograft
• Restores articular surface, prevents engagement

Summary Table

Relevance to This Patient

• 22 years old, active age - high recurrence risk without surgery
• Hill-Sachs lesion: 1.5 cm length, 4 mm depth - relatively modest; exact percentage needs CT 3D reconstruction to quantify
• Bankart lesion: Complete tear 3-6 o'clock with periosteal stripping (classic osseous Bankart pattern)
• Recommended workup: CT scan with 3D reconstruction to quantify glenoid bone loss and determine if the Hill-Sachs lesion is "on-track" or "off-track"
• Likely surgical plan: Arthroscopic Bankart repair ± remplissage depending on CT findings; final decision by the treating orthopedic surgeon

Disclaimer: This information is educational. Treatment must be individualized based on clinical examination, CT bone loss quantification, athletic demands, and the treating surgeon's assessment.