Anatomic Osteochondral Allograft Reconstruction for Concomitant Large Hill-Sachs and Reverse Hill-Sachs Lesions - PubMed (original) (raw)
Anatomic Osteochondral Allograft Reconstruction for Concomitant Large Hill-Sachs and Reverse Hill-Sachs Lesions
Rami G Alrabaa et al. Arthrosc Tech. 2022.
Abstract
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.
© 2022 The Authors.
Figures
Fig 1
Axial computed tomography image of the patient’s left shoulder showing large Hill–Sachs (white arrowhead) and reverse Hill–Sachs lesions (red arrowhead) with the glenohumeral joint dislocated posteriorly engaging into the reverse Hill-Sachs lesion. (C, coracoid; G, glenoid; HH, humeral head.)
Fig 2
Intraoperative photo of the left shoulder after exposure and dislocation of the humeral head from an anterior deltopectoral approach with a subscapularis peel demonstrating adequate access to the humeral head lesions. The arm is placed in extension, adduction, and maximal external rotation to expose the posterior Hill–Sachs (white arrowhead) and anterior reverse Hill–Sachs lesions (black arrowhead). Only a narrow strip of humeral head articular cartilage (HHAC) remains between the 2 lesions. The Hill–Sachs lesion measured 4 cm × 1 cm × 2 cm and the reverse Hill–Sachs lesion measured 5 cm × 1.3 cm × 2 cm. (HHAC, intact humeral head articular cartilage.)
Fig 3
Intraoperative photo of the left shoulder after exposure and dislocation of the humeral head from an anterior deltopectoral approach with a subscapularis peel. The anterior reverse Hill–Sachs defect is first filled with bone wax (BW) to recreate normal anatomy and restore sphericity of the humeral head using the intact humeral head articular cartilage (HHAC) medially and the lesser tuberosity (LT) laterally as guides. (BW, bone wax; HHAC, intact humeral head articular cartilage; LT, lesser tuberosity.)
Fig 4
Intraoperative photo of the left shoulder after an anterior deltopectoral approach with an osteochondral allograft wedge (∗) fixed in the reverse Hill–Sachs lesion with 2 headless compression screws. The native humeral head articular cartilage is labeled (HHAC) as well as the lesser tuberosity (LT). The allograft wedge is fixed flush with the native humeral head articular cartilage. The screw tracks are visible with the 3.5-mm headless compression screws embedded and recessed from the articular surface (Acutrak headless compression screw system; Acumed, Hillsboro, OR). (HHAC, intact humeral head articular cartilage; LT, lesser tuberosity.)
Fig 5
Intraoperative photo of the left shoulder after an anterior deltopectoral approach showing completed fixation of osteochondral allograft wedges in both the reverse Hill–Sachs lesion (∗) and the Hill–Sachs lesion (#). The two osteochondral allograft wedges are anterior and posterior to the native humeral head articular cartilage (HHAC). Both wedges are flush with the native articular cartilage and match the topography well. The headless compression screws are recessed below the articular surfaces of the allograft wedges and are therefore not visible. (HHAC, intact humeral head articular cartilage.)
Fig 6
Intraoperative fluoroscopic images and 6-month follow-up radiographs of the left shoulder after completed fixation of osteochondral allograft wedges for reverse Hill–Sachs and Hill–Sachs lesions. (A) Intraoperative anteroposterior image shows the screws recessed below the articular cartilage. (B) Intraoperative axillary lateral view shows restoration of the native humeral head contour and screws recessed below the articular cartilage. (C and D) Six-month postoperative Grashey and axillary lateral radiographs of the left shoulder demonstrating interval healing of the graft without evidence of resorption.
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