# Bankart and Hill-Sachs Lesions

> Bankart and Hill-Sachs lesions for NEET-PG Orthopaedics: anteroinferior labral tear, engaging defect, critical glenoid bone loss and the Latarjet procedure.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/bankart-and-hill-sachs-lesions
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Campbell's Operative Orthopaedics; Rockwood and Green's Fractures in Adults; Maheshwari Essential Orthopaedics
- How to cite: "Bankart and Hill-Sachs Lesions", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/bankart-and-hill-sachs-lesions

## Direct answer

A Bankart lesion is an avulsion of the anteroinferior glenoid labrum from the rim after anterior shoulder dislocation, while a Hill-Sachs lesion is a compression defect on the posterolateral humeral head struck against the glenoid. Together they drive recurrent anterior instability, and the risk rises when the Hill-Sachs defect engages the glenoid in abduction and external rotation. Surgery is chosen by the size of glenoid bone loss, with the Latarjet procedure favoured when bone loss is critical.

## What you must remember

- **Bankart lesion:** the anteroinferior labrum and inferior glenohumeral ligament torn from the glenoid rim, sometimes with a bony fragment (bony Bankart).
- **Hill-Sachs lesion:** a posterolateral humeral head impaction, seen best on the Stryker notch view (supine, palm on the head, arm elevated) or an AP view in internal rotation.
- **Engaging defect:** the Hill-Sachs lesion catches the anterior glenoid rim in abduction and external rotation, a key cause of recurrence.
- **Glenoid bone loss:** critical bone loss is commonly quoted at about 20 to 25 percent, beyond which soft tissue repair alone tends to fail.
- **Imaging:** CT measures glenoid bone loss and defect size, while MR arthrography assesses the labrum and capsule.
- **Soft tissue repair:** arthroscopic Bankart repair with suture anchors suits limited bone loss without a significant engaging lesion.
- **Bone procedures:** the Latarjet transfers the coracoid with its conjoint tendon for critical bone loss, while remplissage fills an engaging Hill-Sachs defect.

## Matching the operation to the two measurements

The surgical choice depends on two measurements: the glenoid bone loss and whether the Hill-Sachs lesion engages. Each option answers a different combination of the two.

| Option | Best suited to | Key feature |
|---|---|---|
| Arthroscopic Bankart repair | Soft tissue lesion, limited bone loss | Suture anchors restore the labrum |
| Remplissage | Engaging Hill-Sachs with adequate glenoid | Posterior capsule fills the defect |
| Latarjet | Critical glenoid bone loss | Coracoid transfer adds bone and a sling effect |
| Bone graft | Large glenoid defect in selected cases | Bone restores the glenoid contour |

Engagement and bone loss are assessed separately, so a patient may need a bone procedure together with remplissage. Examiners usually expect the candidate to name the threshold and the reason for the choice, rather than simply naming an operation.

## Where the exam tries to catch you

Instability questions reward matching the operation to the lesion rather than to the joint.

- **Trap:** repairing a soft tissue Bankart in a patient with large glenoid bone loss — **Correct:** significant bone loss needs bone augmentation such as the Latarjet, because soft tissue repair alone tends to fail.
- **Trap:** ignoring an engaging Hill-Sachs lesion because the labrum has been repaired — **Correct:** an engaging defect causes recurrence, so it must be assessed and addressed, for example with remplissage.
- **Trap:** assuming every Hill-Sachs lesion needs surgery — **Correct:** small non-engaging defects are often managed with the Bankart repair alone.

## Frequently asked questions

### What is an engaging Hill-Sachs lesion?

An engaging Hill-Sachs lesion is a humeral head defect that catches on the anterior glenoid rim when the arm is abducted and externally rotated. It is a major cause of recurrent dislocation even after a successful labral repair.

### What is the Stryker notch view?

The Stryker notch view is taken supine with the palm on top of the head and the arm elevated about 120 degrees, which profiles the posterolateral humeral head. It is used to identify and size a Hill-Sachs lesion before surgical planning.

### Why is the Latarjet procedure chosen for critical bone loss?

The Latarjet transfers the coracoid with its conjoint tendon to the anterior glenoid, adding a bone block and a sling effect. It is preferred when glenoid bone loss is large enough that soft tissue repair alone is likely to fail.

### What is the critical bone loss threshold in shoulder instability?

Commonly cited figures are around 20 to 25 percent of the glenoid diameter, though authorities differ on the exact value. Bone loss is measured on CT, and the result guides whether bone augmentation is added.