Trivellas Andromahi, Hinton Zoe, Dickens Jonathan F
Orthopaedic Surgery Sports Medicine Department, Duke University, Durham, North Carolina, USA.
Video J Sports Med. 2025 May 22;5(3):26350254251320956. doi: 10.1177/26350254251320956. eCollection 2025 May-Jun.
Shoulder instability events can often result in humeral head and glenoid bone defects. Lesion size, patient age, bone quality, and cause of instability affect management. Surgical options are numerous, depending on severity and complexity. In addressing posterior humeral head lesions, remplissage and humeral head allograft have been reliably described, but the approach to addressing these often significant lesions has been variably illustrated. As recently described by Yazdi et al in a systematic review in 2022, osteochondral allografts for Hill-Sachs or reverse Hill-Sachs lesions showed good patient-reported outcomes. This is in agreement with other studies in the literature, including another systematic review by Saltzman et al in 2015 that reported good outcomes after humeral head allografts for humeral head defects, as well as another study by Gerber et al that reported similar promising outcomes.
Humeral head allograft should be considered in the setting of instability refractory to nonoperative measures in younger patients with large Hill-Sachs and reverse Hill-Sachs lesions, particularly in those that are engaging with the glenoid through range of motion and are over 30% of the depth of the humeral head.
Following an examination under anesthesia and diagnostic arthroscopy, a deltopectoral incision was made from the coracoid to the deltoid insertion. The subscapularis tendon and anterior capsule were both carefully released from their humeral insertion and tagged. Following external rotation of ~180°, the Hill-Sachs defect was visualized, debrided, and molded with bone wax. After an osteochondral humeral head allograft was sized and sculpted on the back table, it was positioned and fixated with provisional Kirscher wires followed by 4-0 cannulated, headless compression screws. Finally, an open Bankart repair was completed, followed by a capsular closure and subscapularis repair.
Humeral head allografts have demonstrated short-term improvements in motion and patient-reported outcome measures and can be used for posterior Hill-Sachs lesions, fully accessible through an anterior approach when anterior instability procedures are also warranted.
DISCUSSION/CONCLUSION: Management of large Hill-Sachs and reverse Hill-Sachs lesions with a humeral head allograft using an anterior open approach is a viable option for patients with refractory instability.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
肩关节不稳定事件常常会导致肱骨头和肩胛盂骨缺损。损伤大小、患者年龄、骨质以及不稳定的原因都会影响治疗方案。手术选择众多，这取决于病情的严重程度和复杂程度。在处理肱骨头后方损伤时，“填充术”和肱骨头同种异体移植已有可靠的描述，但处理这些往往较为严重的损伤的方法却有不同的阐述。正如亚兹迪等人在2022年的一项系统评价中最近所描述的，用于希尔 - 萨克斯或反向希尔 - 萨克斯损伤的骨软骨同种异体移植显示出良好的患者报告结局。这与文献中的其他研究一致，包括萨尔茨曼等人在2015年的另一项系统评价，该评价报告了肱骨头同种异体移植治疗肱骨头缺损后的良好结局，以及格伯等人的另一项研究，该研究报告了类似的良好前景。
对于患有大型希尔 - 萨克斯和反向希尔 - 萨克斯损伤的年轻患者，若非手术措施难以治疗不稳定情况，尤其是那些在活动范围内与肩胛盂相互作用且超过肱骨头深度30%的损伤，应考虑进行肱骨头同种异体移植。
在麻醉下检查和诊断性关节镜检查后，从喙突至三角肌止点做一个三角肌胸大肌切口。小心地从肱骨附着处松解并标记肩胛下肌腱和前方关节囊。在大约180°外旋后，可见希尔 - 萨克斯缺损，用骨蜡进行清创和塑形。在手术台上对骨软骨肱骨头同种异体移植进行测量和塑形后，用临时克氏针定位并固定，随后用4 - 0空心无头加压螺钉固定。最后完成开放性Bankart修复，接着进行关节囊闭合和肩胛下肌修复。
肱骨头同种异体移植已显示出在活动度和患者报告结局指标方面的短期改善，可用于后方希尔 - 萨克斯损伤，当也需要进行前方不稳定手术时，可通过前方入路完全暴露该损伤。
讨论/结论：对于难治性不稳定患者，采用前方开放入路使用肱骨头同种异体移植治疗大型希尔 - 萨克斯和反向希尔 - 萨克斯损伤是一种可行的选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交内容附上患者的豁免声明或其他书面形式的批准，以供发表。
