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

ABSTRACT: Glenohumeral instability causing bipolar bone loss is increasingly being recognized and treated to minimize recurrence. Large Hill–Sachs and reverse Hill–Sachs lesions of the humerus must be addressed at the time of surgery to prevent recurrent dislocations and restore the native anatomic track. For patients with epilepsy, locked dislocations may create defects that must be addressed with bony procedures, including osteochondral allograft reconstruction as soft-tissue remplissage may not adequately addresses the magnitude of the bone loss. Osteochondral allografts have been successfully used to address bony defects ranging from 20% to 30% of humeral bone loss whereas shoulder arthroplasty is indicated for larger defects where the native anatomy can no longer be restored. In this Technical Note, we present a technique to address concomitant large Hill–Sachs and reverse Hill–Sachs lesions. Technique Video Video 1 The patient in this case example has a large Hill–Sachs and reverse Hill–Sachs lesion of the left humeral head. A standard deltopectoral approach is performed. The subscapularis tendon is released via a subscapularis peel directly off of its insertion on the lesser tuberosity directly medial to the long head of the biceps tendon. Adequate release of the inferior capsule is performed to be able to access the humeral head lesions with extension and maximal external rotation. The lesions on the humeral head are prepared into flat surfaces with a sagittal saw. Bone wax is used to fill each defect to recreate native anatomy. The bone wax is used as a template to harvest the same size wedge from the proximal humeral osteochondral allograft on the back table. Two allograft wedges are harvested; one for the Hill–Sachs lesion and the other for the reverse Hill–Sachs lesion. The allograft wedges are fixed into each lesion with 3.5 mm cannulated headless compression screws (Acumed Acutrak headless compression screw system; Hillsboro, OR). The subscapularis is repaired via transosseous suture repair.

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PROVIDER: S-EPMC9939596 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Project description:BackgroundLocked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium-/long-term outcomes of this joint-preserving procedure are controversial.MethodsBetween 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24-225).ResultsAll twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40-97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series.ConclusionSegmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation.Trial registrationClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455 . Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 LEVEL OF EVIDENCE: Level IV, Case Series, Treatment Study.

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

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