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Off-track Hill–Sachs lesions predispose to recurrence after nonoperative management of first-time anterior shoulder dislocations



The purpose of this study was to evaluate whether the presence of an off-track Hill–Sachs lesion has an impact on the recurrence rate after nonoperative management of first-time anterior shoulder dislocations.


A retrospective cohort study was planned with a follow-up via questionnaire after a minimum of 24 months. Fifty four patients were included in the study (mean age: 29.5 years; 16 female, 38 male). All of these patients opted for primary nonoperative management after first-time traumatic anterior shoulder dislocation, in some cases even against the clinician’s advice. The glenoid track and the Hill–Sachs interval were evaluated in the MRI scans. The clinical outcome was evaluated via a shoulder-specific questionnaire, ASES-Score and Constant Score. Further, patients were asked to report on recurrent dislocation (yes/no), time to recurrent dislocation, pain, feeling of instability and satisfaction with nonoperative management.


In 7 (13%) patients, an off-track Hill–Sachs lesion was present, while in 36 (67%) the lesion was on-track and 11 (20%) did not have a structural Hill–Sachs lesion at all. In total, 31 (57%) patients suffered recurrent dislocations. In the off-track group, all shoulders dislocated again (100%), while 21 (58%) in the on-track group and 3 (27%) in the no structural Hill-–Sachs lesion group had a recurrent dislocation, p = 0.008. The mean age in the group with a recurrence was 23.7 ± 10.1 years, while those patients without recurrent dislocation were 37.4 ± 13.1 years old, p < 0.01. The risk for recurrence in patients under 30 years of age was higher than in those older than 30 years (OR = 12.66, p < 0.001).

There were no significant differences between patients with on- and off-track lesions regarding patients’ sex, height, weight and time to reduction and glenoid diameter. Off-track patients were younger than on-track patients (24.9 ± 7.3 years vs. 29.6 ± 13.6 years). However, this difference was not statistically significant.


The presence of an off-track Hill–Sachs lesion leads to significantly higher recurrence rates compared to on-track or no structural Hill–-Sachs lesions in patients with nonoperative management and should be considered when choosing the right treatment option. Therefore, surgical intervention should be considered in patients with off-track Hill–Sachs lesions.

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Correspondence to Frank Martetschläger.

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Dyrna, F.G.E., Ludwig, M., Imhoff, A.B. et al. Off-track Hill–Sachs lesions predispose to recurrence after nonoperative management of first-time anterior shoulder dislocations. Knee Surg Sports Traumatol Arthrosc 29, 2289–2296 (2021).

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  • Shoulder instability
  • Anterior shoulder dislocation
  • Nonoperative management
  • Glenoid track
  • Off-track Hill–Sachs lesion