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

Abstract

Traumatic posterior dislocations of the shoulder can result in bony defects, labral tears, and cartilage injuries of the glenohumeral joint. Although traditional Hill-Sachs lesions from anterior dislocations are more commonly identified, reverse Hill-Sachs lesions caused by posterior dislocation often leads to recurrent engagement of the humeral head with the glenoid and significantly greater damage to the humeral chondral surface. In severe traumatic cases, concomitant damage of the capsulolabral soft tissues, such as circumferential labral lesions, can lead to chronic shoulder instability and residual glenoid bone loss. These lesions further add to the complexity of managing patients with posterior dislocations of the shoulder because of the challenges of achieving adequate anatomic reduction and tensioning of the capsulolabral junction, while also using a combination of arthroscopic and open-labral repair techniques. In the setting of reverse Hill-Sachs lesions treatment, it is important to address the bony and cartilage defect. The purpose of this Technical Note is to describe our preferred technique for arthroscopic repair of circumferential lesions of the glenoid labrum causing multidirectional instability with concomitant reverse Hill-Sachs Lesion treatment with fresh talus osteochondral allograft.

Comprehensive Evaluation and Arthroscopic Management of Circumferential Labral Tears Following Traumatic First Time Shoulder Dislocation: A Case Report and Review

“…It is crucial not to neglect even a single episode of shoulder injury and dislocation with a painful range of motion, especially if radiographs appear normal, as it may indicate a pan-labral lesion [ 16 ]. Left untreated, such lesions can lead to future instability and subsequent painful osteoarthritis [ 17 ].…”

Treatment of Shoulder Cartilage Defects in Athletes

“…55,56 The talar dome shows a high congruence match with the anthropometric properties of the talus is similar to the native humeral head, and the radius of curvature (ROC) of the glenoid. 53,57 The authors of this book chapter have introduced the talar allograft preparation as an orange-slice shape technique and anatomic humeral reconstruction using fresh talus osteochondral allograft 58,59 (Fig. 4).…”

Anatomic Osteochondral Allograft Reconstruction for Concomitant Large Hill–Sachs and Reverse Hill–Sachs Lesions

“…Greater amounts of bone loss may be better treated with osteochondral allograft reconstruction to restore the native anatomy. 6 Similarly, although arthroscopic labral repair with infraspinatus remplissage has been described extensively for anterior shoulder instability with minimal bone loss, 7 locked dislocations with large Hill–Sachs lesions also may benefit from osteoarticular reconstruction. 8 Here, we present a technique for humeral head osteochondral allograft reconstruction for concomitant Hill–Sachs and reverse Hill–Sachs lesions ( Video 1 ).…”