REVIEW ARTICLE


Management of Humeral Defects in Anterior Shoulder Instability



Maria Valencia Mora1, *, Miguel Ángel Ruiz-Ibán2, Jorge Diaz Heredia2, Raquel Ruiz Diaz2, Ricardo Cuéllar3
1 Hospital Fundación Jiménez Diáz, Madrid, Spain
2 Hospital Universitario Ramón y Cajal; Madrid, Spain
3 Hospital Universitario San Sebastían, San Sebastían, Spain


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© 2017 Mora et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Hospital Fundación Jiménez Diáz, Madrid, Spain; Tel: 915504800; E-mail: maria.valencia.mora@gmail.com


Abstract

Background:

A Hill Sachs lesion is a posterior-superior bony defect of the humeral head caused by a compression of the hard glenoid rim against the soft cancellous bone in the context of an anterior instability episode. The presence of these humeral defects increases with the number of dislocations and larger lesions are associated with a greater chance of development of recurrent instability and recurrence after surgery. Also its location and pattern, in particular the so-called engaging Hill-Sachs, are associated with poor prognosis.

Methods:

There is a lack of consensus in terms of classification and management algorithm, although lesions greater than 25% of the humeral head had been suggested to need more than a simple Bankart repair to avoid recurrence. The concept of glenoid track has turned the attention to location and shape and not only size of the humeral defect. Moreover, the glenoid bone loss is crucial when choosing a treatment option as it contributes to decrease the glenoid track as well. A thorough revision of treatment options has been performed.

Results:

Numerous treatment options have been proposed including remplissage, glenoid or humeral head augmentation, bone desimpaction, humeral rotational osteotomy and arthroplasty.

Conclusion:

Humeral defects treatment should be individualized. Determination of size and location of the defect and its relation with glenoid track is mandatory to achieve satisfactory results.

Keywords: Shoulder, Instability, Humeral defect, Remplissage, Autograft, Osteotomy.