Authors’ Reply

To the Editor,

We thank the author for the thoughtful and constructive comments regarding our study evaluating glenoid and coracoacromial morphometry in patients with Hill-Sachs lesions. We appreciate the careful reading of our work and the insightful discussion highlighting the potential clinical implications of scapular morphology in the setting of anterior shoulder instability.

As noted, the primary aim of our study was to describe osseous morphometric differences between patients with Hill-Sachs lesions and a control population using three-dimensional computed tomography. We deliberately focused on static bony parameters to explore whether underlying scapular and glenoid morphology may represent a structural phenotype associated with instability, rather than attempting to integrate functional instability models or clinical outcomes. Accordingly, glenoid bone loss quantification, Hill-Sachs interval measurement, and glenoid track classification were beyond the predefined scope of the present analysis.

We agree that contemporary instability concepts, particularly the glenoid track model, provide valuable insight into engagement risk and surgical decision-making by integrating bipolar bone defects [1]. The morphometric differences observed in our cohort, such as smaller glenoid dimensions and altered inclination, may indeed influence the effective glenoid track and warrant further investigation. As appropriately emphasized, prospective studies incorporating standardized bipolar bone-loss metrics alongside clinical outcomes such as recurrent instability, return to sport, and patient-reported measures would be essential to determine the independent predictive value of these morphologic features.

With regard to the coracoacromial arch, we acknowledge that coracoacromial distance may be influenced by scapular positioning and soft-tissue factors not fully captured by CT imaging. We agree that future work combining standardized imaging protocols with complementary MRI-based soft-tissue assessment could help clarify the relative contribution of fixed osseous morphology versus acquired or modifiable factors, as previously suggested in the literature [2].

We thank the author for placing our findings within a broader conceptual and clinical framework. We believe that our results provide an anatomic foundation upon which future integrative and outcome-oriented studies can build, ultimately contributing to more individualized risk stratification and surgical planning in patients with anterior shoulder instability.