Balloon osteoplasty—a new technique for minimally invasive reduction and stabilisation of Hill–Sachs lesions of the humeral head: a cadaver study

Abstract

Purpose Traumatic shoulder dislocation may be complicated by concomitant bony injury of the glenoid rim or the humeral head. In Hill-Sachs lesions, reconstruction techniques vary widely and range from open reduction to tendon transposition or humeral head derotation. These operations are extensive and have questionable outcomes. With the expertise from vertebral compression fracture reduction by kyphoplasty, we examined in a cadaver feasibility study whether reduction of the Hill-Sachs lesion via hydraulic lift might be an anatomical and minimally invasive treatment option. We postulated that the use a of a balloon-assisted kyphoplasty reduction could achieve almost anatomical correction of the defect. Methods We created Hill-Sachs lesions in six humeral specimens and performed a computed tomography (CT) scan before and after reduction with the kyphoplasty system. The entry point at the greater tuberosity and balloon positioning was visualised by fluoroscopy. The size of the HillSachs lesion before and after reduction was measured using CT scans in the axial orientation. Results Using the balloon kyphoplasty system, we achieved a statistically significant reduction (80 % ) of the Hill-Sachs lesion. Conclusion In a preliminary cadaver study we show that using a balloon kyphoplasty system might be an alternative treatment option for Hill-Sachs lesions, with reduced collateral damage that can occur with other minimally invasive techniques. Future work is needed to evaluate the technique under arthroscopic conditions.

Arthroscopic Reduction and Balloon Humeroplasty in the Treatment of Acute Hill-Sachs Lesions

“…Kazel et al 11 were the first authors to coin the term "humeroplasty," when they created Hill-Sachs lesions in 14 cadaveric specimens and then used a curved bone tamp to significantly reduce the size of the lesions. Sandmann et al 12 advanced the technique further and used a kyphoplasty balloon to reduce the size of a HillSachs lesion. They used 6 cadaveric specimens for their study and showed that a balloon kyphoplasty system could reduce the size of a Hill-Sachs lesion by 80%, but they noted that further studies needed to be performed to evaluate the technique under arthroscopic conditions.…”

“…More recently, Sandmann et al 12 described the use of a kyphoplasty balloon with subsequent filling of the defect with bone substitute (similar to the fixation of a vertebral compression fracture), which they performed on cadaveric specimens. Stachowicz et al 13 described the same technique used on cadavers.…”

Deployable and Conformal Planar Micro-Devices: Design and Model Validation

“…They also target limited geometries, as they very often rely on inflatable balloons for deployment [6,7]. Adapting these device designs for planar configurations while at the same time providing the ability to incorporate electrical, optoelectronic and other sensing and actuation capabilities are highly desirable to further expand the usage of deployable devices and to facilitate the exploration of novel applications.…”

Is balloon osteoplasty attractive or questionable treatment for Hill-Sachs lesion?

“…Dear Editor, We have read the article "Balloon osteoplasty-a new technique for minimally invasive reduction and stabilisation of Hill-Sachs lesions of the humeral head: a cadaver study" by Sandmann et al [1] with great interest.…”