Management of Anterior Glenohumeral Instability Associated With Large Hill–Sachs Defects

Anatomic pathology following shoulder instability includes capsulolabral injury as well as bone defects on both the glenoid and humeral head. The common surgical repairs address the soft tissue labral tears (Bankart lesions) as well as the capsular redundancy that occurs with these injuries. These soft tissue repairs are usually sufficient to deal with most instability cases. Unfortunately, in certain circumstances, bone deficiency of the glenoid or of the humeral head (Hill–Sachs) may give rise to ongoing instability of the glenohumeral joint that is not controlled by soft tissue repairs alone. Although rare, Hill–Sachs lesions have been reported to play a role in the failures of anterior glenohumeral instability surgical repairs. Various methods have been reported to treat these Hill–Sachs lesions, including tight soft tissue reconstructions and derotational osteotomies. We describe a technique that accomplishes an anatomic reconstruction of the humeral head using a side- and size-matched humeral head osteoarticular allograft. This technique involves an anatomic reconstruction, which eliminates the structural bone pathology while maintaining the range of motion of the glenohumeral joint. We have reported a series of patients where Hill–Sachs defects were reconstructed for recurrent traumatic anterior instability following failed repairs. This technique has been shown to be effective for a difficult problem with few available treatment options. While associated with some residual disability, it has led to a high subjective approval, allowing return to near normal function with no further instability.