Summary

Arthroscopic Hill-Sachs lesion filling with osteochondral autograft transplantation is a viable anatomical option that may improve clinical outcomes in patients with primary or recurrent glenohumeral instability.

Abstract

Near-track lesions recently showed an increased risk of failure after Bankart repair. Although several techniques have been described to address subcritical glenoid bone loss, the management of the Hill-Sachs (HS) lesions remains a challenge. The purpose of this study is to present an arthroscopic technique to fill the articular portion of the HS lesion with osteochondral autografts harvested from the ipsilateral knee and to report the functional outcomes in a series of cases managed with this technique.

Methods

The study included candidates with primary or recurrent anterior glenohumeral instability, evidenced by a near-track lesion on a computed tomography (CT) scan. The surgical procedure involved filling the articular humeral head (HH) with osteochondral autografts harvested from the lateral border of the lateral femoral condyle of the knee. The primary outcome was the recurrence of dislocation, while secondary functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score and the WOSI (Western Ontario Shoulder Instability) score. The Wilcoxon signed-rank test was used to compare patient-reported outcomes (PROMs) at baseline and at follow-up. Significance was set for p<0.05.

Results

A total of 6 patients (5 males and 1 female) were included in the study (mean age, 26.3 + 3.9 years; range, 21–33 years). The mean follow-up duration was 16.3 + 3.1 months (range, 12–21 months). No cases of dislocation recurrence have been recorded, and no cases showed persistent apprehension upon clinical evaluation. The mean ASES and WOSI scores at baseline were 76.7 ± 15.4, and 43.8 ± 10.6, respectively. Mean scores at follow-up were 95.8 ± 7.8, and 7.7 ± 4.6 points for ASES and WOSI, respectively. The improvement was significant for both PROMs. (p = 0.027 and p = 0.028 for ASES and WOSI, respectively). No symptoms related to the harvest site were reported.

Conclusion

The arthroscopic HH filling with osteochondral autograft transplantation for near-track HS lesions is a viable anatomical option that may improve clinical outcomes in patients with primary or recurrent glenohumeral instability.