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Bankart lesion with glenoid bone defect - CT assessment with PICO method

Case contributed by Domenico Nicoletti
Diagnosis certain

Presentation

Fall with outstretched arms.

Patient Data

Age: 25 years
Gender: Male

Post anterior shoulder dislocation.

Bankart lesion: glenoid labral tear at 3-6 o'clock with small bone fragment and humeral head Hill Sachs lesion. Defect assessment with PICO method: 18%.

The angle of the Hill-Sachs lesion is 41°.

Case Discussion

The PICO method on 2D-CT en face view is used to quantify the glenoid bone defect area and percentage of bone loss. Glenoid bone defect is anterior shoulder dislocations characteristic.

Before treatment, glenoid bone defect quantification with PICO method, is required to select the best option (arthroscopy vs open surgery with bone transposition). A glenoid bone defect more than 15-20% is the main contraindication to arthroscopic stabilization.

Open surgery should be considered if there is glenoid bone loss >25%, a lesion involving >30% of the humeral head, an engaging Hill-Sachs lesion, or bipolar bone lesions even without engagement.

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