The significance of the Hill-Sachs lesion in relation to recurrent anterior dislocations of the shoulder has been well described. While numerous procedures have been devised for the treatment of recurrent anterior shoulder dislocations associated with these defects, none are directly aimed at correcting the lesion itself. A percutaneous bone tamp has been used successfully in treating central tibial articular depressions seen in plateau fractures. We propose that the percutaneous bone tamp can be used to correct or decrease the size of large Hill-Sachs defects which we will term “humeroplasty.” The purpose of our study was to evaluate whether percutaneous humeroplasty can be used to achieve correction of a large Hill-Sachs defect. Our hypothesis is that percutaneous humeroplasty can reduce large Hill-Sachs lesions to normal. Fourteen cadaveric humeri were used for our study. The average age was 49.9 years. There were 13 males, 1 female. A reproducible, “significant” Hill-Sachs defect that was morphologically similar to in vivo lesions was created, as defined by previous studies. Defect arc depth, arc width and the length were then measured and will be used to calculate the volumetric loss from the Hill-Sachs lesion as well as volume restoration following humeroplasty. The defect was then reduced visually and under fluoroscopic guidance using our percutaneous humeroplasty technique. This technique involves a 10-mm diameter cortical window created in the mid-greater tuberosity just lateral to the bicipital groove, through which the curved bone tamp is directed to the defect and correction is obtained. The residual defect following humeroplasty was then measured and recorded. Paired t tests were used to compare the pre- to post-humeroplasty parameters including arc depth, width, length, and volume as well as comparing post-humeroplasty measurements to no defect. Significance is set at P = .05. The average arc depth, width, length, and volume of the Hill-Sachs defect measured 8.9 mm, 16.3 mm, 24.1 mm, and 1755.6 mm3, respectively. Following percutaneous humeroplasty, these defects were reduced to 1.6 mm, 6.2 mm, 10.4 mm, and 50.3 mm3, respectively. All reductions were statistically significant (P < .001). When the reduced defect arc depth, width, length, and volume were compared with no defect (0 mm or 0 mm3), there was a statistically significant difference in all parameters (P < .001). We were able to reproducibly create large Hill-Sachs deformities in vitro. While we were not able to prove our hypothesis that percutaneous humeroplasty can reduce large Hill-Sachs lesions to normal, we were able to significantly reduce these to “small” defects, as described in previous clinical studies. This reduction of the Hill-Sachs lesion to a “small” defect may prevent the increased risk of recurrence normally seen following the surgical treatment of anterior shoulder instability with large Hill-Sachs defects. Additional cadaveric research followed by clinical studies is needed to further investigate percutaneous humeroplasty as a viable technique for the treatment of anterior shoulder instability with large Hill-Sachs lesions.
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