Hill-Sachs lesion is not a significant prognostic factor for recurrence of shoulder redislocation after arthroscopic Bankart repair

Importance Humeral head defects are a common finding after acute and recurrent shoulder dislocations. Different hypotheses exist on the real significance of these defects and on their relevance in predicting dislocations after surgical repair. Objective This review study was designed to evaluate if humeral head defects are a negative prognostic factor for recurrence after arthroscopic Bankart repair. Evidence review A systematic review of the available literature (1980–2015) was performed using EMBASE and MEDLINE databases. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. Findings A meta-analysis on instability recurrence risk after arthroscopic Bankart repair and recurrence rate stratification for time from intervention were not possible for lack of data. 23 studies were eligible for inclusion. The ratio between recurrence cases and total cases was 0.1254. This ratio rose to 0.1314 in the group with HillSachs lesions and dropped to 0.1044 in the group without. 10 patients reported the dimension of the Hill-Sachs encountered and 6 reported precisely the time to instability recurrence in presence or absence of Hill-Sachs lesions. Conclusions and relevance A Hill-Sachs lesion could not be confirmed as a statistically significant negative prognostic factor after arthroscopic Bankart repair. With increased follow-up length, a slight tendency to higher redislocation rates was observed in presence of a Hill-Sachs lesion. Higher quality studies with repair survival analysis are needed to assess recurrence risk after arthroscopic Bankart repair and evaluate the prognostic relevance of the presence of a Hill-Sachs lesion.