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Arthroscopic treatment of a reverse hill-sachs lesion.

ABSTRACT: Acute traumatic posterior shoulder instability is a rare injury. Such injuries can result in significant bone defects of the anterior humeral head that require surgical intervention. In the past, small to medium defects have been treated by a soft-tissue or bone transfer into the lesion. We present an arthroscopic technique for addressing these lesions in which the middle glenohumeral ligament is sutured into the defect, thereby making it an extra-articular defect and preventing it from engaging the posterior glenoid.

SUBMITTER: Duey RE

PROVIDER: S-EPMC3716231 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Arthroscopic treatment of a reverse hill-sachs lesion.

Duey Richard E RE Burkhart Stephen S SS

Arthroscopy techniques 20130502 2

Acute traumatic posterior shoulder instability is a rare injury. Such injuries can result in significant bone defects of the anterior humeral head that require surgical intervention. In the past, small to medium defects have been treated by a soft-tissue or bone transfer into the lesion. We present an arthroscopic technique for addressing these lesions in which the middle glenohumeral ligament is sutured into the defect, thereby making it an extra-articular defect and preventing it from engaging ...[more]

PMID: 23875143

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Project description:Glenohumeral instability causing bipolar bone loss is increasingly being recognized and treated to minimize recurrence. Large Hill–Sachs and reverse Hill–Sachs lesions of the humerus must be addressed at the time of surgery to prevent recurrent dislocations and restore the native anatomic track. For patients with epilepsy, locked dislocations may create defects that must be addressed with bony procedures, including osteochondral allograft reconstruction as soft-tissue remplissage may not adequately addresses the magnitude of the bone loss. Osteochondral allografts have been successfully used to address bony defects ranging from 20% to 30% of humeral bone loss whereas shoulder arthroplasty is indicated for larger defects where the native anatomy can no longer be restored. In this Technical Note, we present a technique to address concomitant large Hill–Sachs and reverse Hill–Sachs lesions. Technique Video Video 1 The patient in this case example has a large Hill–Sachs and reverse Hill–Sachs lesion of the left humeral head. A standard deltopectoral approach is performed. The subscapularis tendon is released via a subscapularis peel directly off of its insertion on the lesser tuberosity directly medial to the long head of the biceps tendon. Adequate release of the inferior capsule is performed to be able to access the humeral head lesions with extension and maximal external rotation. The lesions on the humeral head are prepared into flat surfaces with a sagittal saw. Bone wax is used to fill each defect to recreate native anatomy. The bone wax is used as a template to harvest the same size wedge from the proximal humeral osteochondral allograft on the back table. Two allograft wedges are harvested; one for the Hill–Sachs lesion and the other for the reverse Hill–Sachs lesion. The allograft wedges are fixed into each lesion with 3.5 mm cannulated headless compression screws (Acumed Acutrak headless compression screw system; Hillsboro, OR). The subscapularis is repaired via transosseous suture repair.

Dataset Information

Arthroscopic treatment of a reverse hill-sachs lesion.

Publications

Arthroscopic treatment of a reverse hill-sachs lesion.

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