Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review.

ABSTRACT Purpose To perform a systematic review evaluating the accuracy and reliability of various imaging modalities utilized to assess for presence of and to quantify Hill-Sachs lesions in patients with anterior shoulder instability. Methods A systematic review was performed according to the PRISMA guidelines using PubMed, Scopus, Embase, and Cochrane library databases. Inclusion criteria were clinical trials or cadaver studies that assessed for the accuracy of humeral head bone loss imaging or reliability, and English language. Exclusion criteria were animal studies, imaging studies without measures of accuracy, reliability, or clinical predictive power, shoulder injuries without humeral head bone loss, editorial articles, abstracts, reviews, case reports, and surveys. The search terms included “Imaging” OR “Radiographic” OR “CT” OR “MRI” AND “Hill-Sachs” OR “Humeral Head Bone Loss.” The methodological quality assessment of the included studies was performed by using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS 2) tool. Results 40 studies (2,560 shoulders) met inclusion criteria and were assessed. For diagnosing the presence of Hill-Sachs lesions, computed tomography arthrogram (CTA) was found to have the highest reported accuracy (median = 91%, range = 66-100%). For the same assessment, CTA was also found to have the greatest reported sensitivity (median = 94%, range = 50-100%). For the quantification of Hill-Sachs lesion parameters, reported intraobserver reliabilities were highest for 3-dimensional computed tomography (3D CT) (ICC range = 0.916-0.999) followed by 2-dimensional computed tomography (2D CT) (ICC range = 0.858-0.861) and magnetic resonance imaging (MRI) (ICC range = 0.28-0.97). For the same quantification parameters, interobserver reliabilities were also reported for 3D CT (ICC range = 0.772-0.996), 2D CT (ICC range = 0.721-0.879), MRI (Kappa range = 0.444-0.700). Intraobserver reliabilities for determining glenoid tracking were only reported for 3D CT (Kappa range = 0.730-1.00; ICC range = 0.803-0.901) and MRI (ICC range = 0.770-0.790). Conclusion This study demonstrates that the current literature supports verity of different imaging modalities that provides clinically acceptable accuracy in diagnosing, quantifying, and determining if a Hill-Sachs Lesions will cause persistent anterior shoulder instability. Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm in the proper imaging modalities needed to help treat patients suffering from anterior shoulder instability that is both reliable and financially acceptable.