Transhumeral Head Plasty for Large Hill-Sachs Lesions

Large, engaging Hill-Sachs lesions can cause recurrent glenohumeral instability following Bankart repair of torn anterior capsulolabral structures. We offer a novel technique for correcting the posterolateral humeral head defect without significantly altering normal anatomic structures. The glenohumeral joint is exposed via a deltopectoral approach. After the defect geometry is appreciated by direct palpation and visualization, the tip of an anterior cruciate ligament tibial guide is centered in the defect. The drill sleeve is approximated to the anterior lesser tuberosity starting hole, and a graduated guidewire is advanced to the posterior subchondral surface. After confirmation of satisfactory positioning, an 8-mm cannulated acorn drill is drilled to within 1 cm of the posterior surface. Bone tamps are used to elevate the depressed area using the tunnel created within the head. Allograft cancellous bone chips are impacted into the defect to elevate and support the subchondral surface. After successful impaction grafting and restoration of the head surface, anterior capsulolabral reconstruction is undertaken using either the Bankart or Latarjet technique. A standard Bankart rehabilitation program is followed postoperatively. We confirmed the clinical efficacy of our technique in 4 patients who experienced no instability or other complications at an average of 1-year follow-up.