Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

Abstract

The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.

Posterior shoulder dislocation with reverse Hill-Sachs lesion. A technical note and report of two cases

“…This article describes the application of both together, modified McLaughlin procedure and posterior Bankart repair, and presents two patients with mid-term clinical outcome. Although both procedures are not always combined in the literature, to our knowledge, our cases are the first ones in the literature documenting that modified McLaughlin procedure potentially is not enough, confirming that the clinical outcome is more reliable after the combination of both procedures [4][5][6].…”

Fresh Osteochondral Allograft Transplantation for Focal Chondral Defect of the Humerus Associated With Anchor Arthropathy and Failed SLAP Repair

“…OCA transplantation of the humeral head has previously been described for the treatment of Hills-Sachs lesions associated with glenohumeral instability. 4 , 5 , 6 , 11 Promising results have also been reported using this technique for humeral head articular cartilage defects. 1 , 8 Although arthroscopic management techniques have shown some success with small glenohumeral defects, larger defects and those with subchondral bone involvement may benefit from OCA transplantation.…”

“… 12 , 13 By broadening matching criteria, these radius of curvature matching investigations have the potential to reduce graft wait times and optimize available graft utilization. 5 Future advances for all OCA techniques include the use of CO 2 lavage, which has been shown to improve the clearance of bone marrow elements from donor grafts. 14 This has the potential to decrease immunogenicity of the donor grafts and improve graft incorporation.…”

“…Hill-Sachs lesions). 4 , 5 , 6 Previously, OCA has shown excellent outcomes for treating articular lesions in the knee, 7 and the initial results reported for defects of the glenohumeral joint have yielded promising results. 1 , 8 Although the cause is not always clear in cases of avascular necrosis or chondrolysis, numerous cases of osteochondral defects associated with anchor arthropathy have been reported in the literature.…”

Multidirectional Shoulder Instability With Circumferential Labral Tear and Bony Reverse Hill Sachs: Treatment with 270° Labral Repair and Fresh Talus Osteochondral Allograft to the Humeral Head

“…15 Because rHSLs have been reported to be associated with greater cartilage damage than traditional HSLs, fresh talus allograft has emerged as a viable procedure to best reproduce the native curvature and cartilage surface of the humeral head, while also serving to minimize infection because of its peripherally located harvest site (Table 1). 16 However, there is a paucity of literature regarding outcomes of combined circumferential labral repair and humeral or glenoid bone grafting procedures, and future studies are needed Fresh talus allograft fixation in a left shoulder. The defect is again measured to ensure proper sizing of the allograft (A).…”