Hybrid Treatment of Engaging Hill-Sachs Lesions

A humeral head impression fracture, more commonly known as a Hill-Sachs lesion, can play an important role in recurrent anterior shoulder instability. Lesions that are large enough and in the appropriate alignment to engage the anterior glenoid rim may require surgical treatment to reestablish functional shoulder stability. These lesions are occasionally treated with bone grafting, usually performed via an anterior deltopectoral approach. We describe our "hybrid" technique of treating this lesion via arthroscopic capsulolabral repair coupled with an open posterior approach to the humeral head, which involves splitting the posterior deltoid and the infraspinatus muscles. We also provide an illustrative example of a case in which this technique was used.