Humeral Head Bone Grafting of a Large Off-Track Hill-Sachs Lesion Using Femoral Condyle Osteochondral Allograft Through a Percutaneous Posterior Approach

Abstract

Hill-Sachs lesions (HSLs) are commonly associated with anterior shoulder instability with or without glenoid bone defects. Treatment decision mainly depends on the size and location of the defect on the humeral head. Osteochondral allograft transplantation has been described for the treatment of large off-track HSLs. However, concerns have been raised due to concerns accessing the HSL and associated complications, predominantly due to the anterior aspect of the deltopectoral approach and subscapularis tenotomy used to gain access to these lesions. In addition, most of the studies used a lemon-wedge-shaped allograft to restore the defect, which can be technically demanding and time-consuming. This Technical Note aims to describe a posterior approach to the humeral head through an infraspinatus split that allows for accurate humeral head reconstruction with cylindrical osteochondral allografts in the setting of primary or recurrent anterior shoulder instability with large, off-track HSLs.