Abstract
PurposeTo investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions.MethodsPatients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan.ResultsNineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes.ConclusionOsteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable.Level of evidenceLevel IV, case series
Highlights
Hill-Sachs lesions, which were first described by Hill and Sachs in 1940, typically occur when the softer posterolateral humeral head impacts the harder anteroinferior glenoid rim during traumatic anterior glenohumeral dislocation events [1]
Small to mid-sized Hill-Sachs lesions can be effectively treated by arthroscopic remplissage, the treatment of large Hill-Sachs lesions involving > 30% of the humeral head remains a significant challenge for orthopedic surgeons [4, 5]
Various methods have been reported for the treatment of large Hill-Sachs lesions, including rotational osteotomy, Latarjet, humeral head reconstruction with an allograft, and arthroplasty [6, 7]
Summary
Hill-Sachs lesions, which were first described by Hill and Sachs in 1940, typically occur when the softer posterolateral humeral head impacts the harder anteroinferior glenoid rim during traumatic anterior glenohumeral dislocation events [1]. The incidence of Hill-Sachs lesions in first shoulder dislocation is 40 to 90% and nearly 100% in recurrent shoulder dislocation [2]. As these anomalies lead to an articular arc mismatch between the glenoid and humeral head, Hill-Sachs lesions are a well-. Small to mid-sized Hill-Sachs lesions can be effectively treated by arthroscopic remplissage, the treatment of large Hill-Sachs lesions involving > 30% of the humeral head remains a significant challenge for orthopedic surgeons [4, 5]. Various methods have been reported for the treatment of large Hill-Sachs lesions, including rotational osteotomy, Latarjet, humeral head reconstruction with an allograft, and arthroplasty [6, 7].
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