Thanks Munib for sharing our article.
BTW- our shoulder surgeons-4 of them do not like-
– Remplissage- creates unusual stiffness in shoulder- worse than instability.
– Rotator cuff grafts or meniscus transplants- as all of them fail!
So if you haven’t encountered them- don’t worry!
Happy new year from Tx!
Best!
AC
Avneesh Chhabra, M.D. M.B.A.
Professor, Radiology & Orthopedic Surgery
Chief, Musculoskeletal Radiology
Department of Radiology
5323 Harry Hines, Blvd. Dallas, Tx-75390-9316
Office: 214-648-2122
On Jan 9, 2023, at 11:25 AM, Munib Sana <munibsana> wrote:
EXTERNAL MAIL
Delayed follow up on this question but holidays, kids, life, etc…
Sounds like the consensus is Yes, but only for very large HS lesions. May help surgeons decide on Remplissage. Practically, I think I’ll just eyeball it and not comment on on/off track with unipolar bone loss unless there is a massive HS lesion. Seems like a waste of time to measure all of these.
Thanks for all who responded and here is an article that was emailed to me.
Gulati A, Dessouky R, Wadhwa V, Sanders D, Chhabra A. New concepts of radiologic preoperative evaluation of anterior shoulder instability: on-track and off-track lesions. Acta Radiol. 2018 Aug;59(8):966-972. doi: 10.1177/0284185117745573. Epub 2017 Dec 7. PMID: 29216740.
Munib Sana, MD
Musculoskeletal Radiologist
Director of Outpatient Imaging
Colorado Imaging Associates
Denver, COOn Tue, Dec 6, 2022 at 9:10 PM Munib Sana <munibsana> wrote:
TL;DR – Do you give an on/off track assessment on patients without bipolar bone loss? They just have a Hill Sachs. No bony bankart.
Hey everyone. I’ve been doing on/off track measurements for our ortho surgeons for a few years now, but only on patients who have bipolar bone loss. I was recently asked by one of them to give an assessment for a patient who just had a HS lesion. No bony bankart and therefore no bipolar bone loss.
I thought on/off track was only applicable to patients who had bipolar bone loss, but I guess one could theoretically have such a large HS lesion that it could be off track with a normal glenoid…But then what does the surgeon even do with that information? I thought on/off track was to help them decide between an osseous repair (Latarjet) vs a soft tissue repair. I can’t imagine they’d Latarjet someone without glenoid bone loss. I explained my thought process to the surgeon and he didn’t know either. So I ask you all, am I dumb or is he the dum-dum?
As an aside, I have seen some cases where the HS is so laterally positioned that it’s completely or nearly completely deep to the infraspinatus insertion which means there’s no Hill Sachs Index so I also can’t give an on/off track assessment. It’s a functional Remplissage is how I’ve worded it to the surgeons. They don’t seem very satisfied with that answer either. Any thoughts on that odd variation to this coveted assessment would also be helpful.
Thanks!
Munib Sana, MD
Musculoskeletal Radiologist
Director of Outpatient Imaging
Colorado Imaging Associates
Denver, CO
