After an anterior dislocation: the anteroinferior labral tear (Bankart and variants), the Hill–Sachs lesion, and — what decides the operation — the amount of glenoid bone loss and whether the Hill–Sachs is on- or off-track.
Orient first
- Bankart: anteroinferior labrum detached with the torn periosteum; ALPSA and Perthes are variants; bony Bankart includes a glenoid fragment.
- Glenoid track concept: an off-track Hill–Sachs engages the glenoid rim and needs bone augmentation (verify method).
- MR arthrography improves labral assessment; CT with 3D en-face glenoid measures bone loss.
Acquire the study
- Axial, oblique coronal and oblique sagittal PD fat-saturated; T1 fat-saturated in ABER position for MR arthrography.
The manoeuvre
- Axial images from 3 to 6 o'clock: anteroinferior labrum detachment and periosteal status.
- HAGL on oblique coronal: humeral avulsion of the glenohumeral ligament.
- Posterolateral humeral head on axial: Hill–Sachs impaction — depth and width in mm.
- Oblique sagittal en-face glenoid: bone loss estimated with the best-fit circle in %.
- Rotator cuff in older patients (dislocation tears the cuff).
What confirms it
- Anteroinferior labral detachment with a Hill–Sachs lesion after a dislocation.
What licenses you to exclude it
- An intact anteroinferior labrum and no Hill–Sachs on MR arthrography make a structural instability lesion unlikely.
The classic misread
- Calling the sublabral foramen or Buford complex (anterosuperior) a tear.