Arthroscopic-Assisted Treatment of a Reversed Hill-Sachs Lesion: Description of a New Technique Using Cerament

Abstract

Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute. Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM. Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

Giant Solitary Cyst at the Site of Knee Osteoarthritis: Treatment with a Synthetic Resorbable Bone Graft Substitute and Primary Total Knee Arthroplasty

“…The ratio results in a mixture with compressive strength (wet) of 5–8 MPa, comparable to trabecular bone [ 5 ]. Good and excellent results have been published about its use in the management of reverse Hill-Sachs lesions [ 4 ] and tibial plateau fractures [ 5 ] and in spine [ 8 – 10 ], tumor [ 6 ], and hand surgery [ 7 ]. Osseointegration was not disrupted when it was used as a coating on implants [ 12 ].…”

“…Advantages of this treatment option involve excellent handling properties including reliable injectability, enhanced radio-opacity, and fast remodeling to bone, which might make it an attractive alternative to autologous bone or allografts [ 6 ]. Furthermore, there is no donor site morbidity [ 10 ], and it can be also performed minimal-invasive, percutaneous, or arthroscopically [ 4 , 10 ].…”