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A Technique to Reduce Hill-Sachs Lesions After Acute Anterior Dislocation of the Shoulder

Stehle, Jens MD1; Wickwire, Alexis C BS1; Debski, Richard E PhD1; Sekiya, Jon K MD2

Techniques in Shoulder & Elbow Surgery: December 2005 - Volume 6 - Issue 4 - pp 230-235
Review

Some patients with Hill-Sachs lesions experience recurrent glenohumeral instability even after anterior capsulolabral repairs. Numerous procedures exist for recurrent anterior instability with large Hill-Sachs lesions but few of these procedures are directly aimed at correcting the lesion itself or restoring normal anatomy, and some of these “solutions” have well known complications, such as increased glenohumeral arthritis. This article will introduce a novel experimental technique for treatment of engaging Hill-Sachs lesions called “humeroplasty,” which anatomically corrects or decreases the size of acute large Hill-Sachs lesions. It utilizes a similar technique previously described for successfully treating tibial plateau fractures using a bone tamp. In cadaveric studies, humeroplasty was able to reduce the defect size of the Hill-Sachs lesions. This reduction in defect size after humeroplasty might clinically reduce the higher rate of recurrent anterior shoulder instability observed when the surgical treatment of shoulder instability involves the presence of large Hill-Sachs lesions. The most important aspect of this technique is that it can be done percutaneously with minimal invasiveness, preserving the deltoid origin. Additionally, because all capsulolabral injuries can be arthroscopically repaired first, the decision for humeroplasty can be reassessed intraoperatively during the arthroscopic examination of the glenohumeral joint.

1Musculoskeletal Research Center (MSRC), Department of Bioengineering, University of Pittsburgh, PA

2Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA

Reprints: Jon K. Sekiya, MD, Assistant Professor, Center for Sports Medicine, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203 (e-mail: jsekiya@hotmail.com).

© 2005 Lippincott Williams & Wilkins, Inc.