Lee Jared T, Adriani Marco, DeFoor Mikalyn T, Whalen Ryan J, Cortes Natalie, Provencher Matthew T
The Steadman Clinic, Aspen, Colorado, U.S.A.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthrosc Tech. 2024 Oct 24;14(4):103288. doi: 10.1016/j.eats.2024.103288. eCollection 2025 Apr.
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.
希尔-萨克斯损伤（HSLs）通常与伴有或不伴有肩胛盂骨缺损的前肩不稳相关。治疗决策主要取决于肱骨头缺损的大小和位置。骨软骨异体移植已被用于治疗大型偏离轨迹的HSLs。然而，由于担心进入HSL及相关并发症，主要是由于用于进入这些损伤的三角肌胸大肌入路的前方和肩胛下肌切断术，人们对此提出了担忧。此外，大多数研究使用柠檬楔形异体移植来修复缺损，这在技术上可能要求较高且耗时。本技术说明旨在描述一种通过冈下肌劈开的肱骨头后入路，该入路允许在原发性或复发性前肩不稳伴有大型偏离轨迹的HSLs的情况下，用圆柱形骨软骨异体移植进行准确的肱骨头重建。
