Focal Resurfacing of Humeral-Head Defects

  • Pradeep Kodali
  • Anthony Miniaci


Traumatic shoulder instability is extremely common in athletes. It is usually due to abnormal abduction, external rotation, and extension force on the shoulder, causing it to exceed normal limits of glenohumeral motion and resulting in anterior dislocation. A characteristic anteroinferior capsulolabral injury occurs and has been deemed the essential lesion in anterior shoulder instability [1]–[3]. A posterosuperior humeral-head defect (Hill-Sachs lesion) is noted in 93% of cases [4]. This bone defect, if large enough, may contribute to failed soft tissue stabilization that occurs in 8–18% of patients [4]–[6]. Large defects lead to an articular arc mismatch that, at lesser degrees of external rotation, will engage with the anteroinferior glenoid, causing instability [7]. Treatment typically entails a combined procedure to address the soft tissue injury and bone defect. For large Hill-Sachs lesions, surgical options include nonanatomic techniques, such as the remplissage procedure [4], [8], or anatomic techniques. Purchase et al. [8] used an arthroscopic remplissage technique and had only a 7% chance of recurrent instability. Anatomic techniques include either matched humeral-head allograft or resurfacing arthroplasty with HemiCAP© (Arthrosurface, Franklin, MA, USA) [9]. Allograft transplantation for Hill-Sachs lesions has been described and yields good outcomes in most case reports [10]–[12].


External Rotation Shoulder Instability Allograft Transplantation Recurrent Instability Anterior Shoulder Instability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bankart AS, Cantab MC (1993) Recurrent or habitual dislocation of the shoulder-joint. 1923. Clin Orthop Relat Res 291:3–6PubMedGoogle Scholar
  2. 2.
    Bankart ASB (1923) Recurrent or habitual dislocation of the shoulder joint. Br Med J 1:1132CrossRefGoogle Scholar
  3. 3.
    Bankart ASB (1938) The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 26:23CrossRefGoogle Scholar
  4. 4.
    Lynch JR, Clinton JM, Dewing CB et al (2009) Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg 18:317–328PubMedCrossRefGoogle Scholar
  5. 5.
    Lenters TR, Franta AK, Wolf FM et al (2007) Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 89:244–254PubMedCrossRefGoogle Scholar
  6. 6.
    Pelet S, Jolles BM, Farron A (2006) Bankart repair for recurrent anterior glenohumeral instability: results at twenty-nine years’ follow-up. J Shoulder Elbow Surg 15:203–207PubMedCrossRefGoogle Scholar
  7. 7.
    Burkhart SS, Danaceau SM (2000) Articular arc length mismatch as a cause of failed bankart repair. Arthroscopy 16:740–744PubMedCrossRefGoogle Scholar
  8. 8.
    Purchase RJ, Wolf EM, Hobgood ER et al (2008) Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 24:723–772PubMedCrossRefGoogle Scholar
  9. 9.
    Moros C, Ahmad CS (2009) Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability. Orthopedics 32(8)Google Scholar
  10. 10.
    Chapovsky F, Kelly JD (2005) Osteochondral allograft transplantation for treatment of glenohumeral instability. Arthroscopy 21:1007PubMedCrossRefGoogle Scholar
  11. 11.
    Yagishita K, Thomas BJ (2002) Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocation. A case report. Injury 33:791–794PubMedCrossRefGoogle Scholar
  12. 12.
    Kropf EJ, Sekiya JK (2007) Osteoarticular allograft transplantation for large humeral head defects in glenohumeral instability. Arthroscopy 23:322 e321–322 e325Google Scholar
  13. 13.
    Miniaci A, Berlet G, Hand C, Lin A (2008) Segmental humeral head allografts for recurrent anterior instability of the shoulder with large Hill-Sachs defects: a two to 8 year follow up. J Bone Joint Surg Br 90(Supp 1):86Google Scholar
  14. 14.
    Bernageau J, Patte D, Debeyre J, Ferrane J (1976) [Value of the glenoid profil in recurrent luxations of the shoulder]. Rev Chir Orthop Reparatrice Appar Mot 62(2 suppl):142–147PubMedGoogle Scholar
  15. 15.
    Ito H, Shirai Y, Takayama A, Shibasaki T (1996) A new radiographic projection for the posterolateral notch in cases of recurrent dislocation of the shoulder. Nippon Ika Daigaku Zasshi 63:499–501PubMedGoogle Scholar
  16. 16.
    Kralinger FS, Golser K, Wischatta R et al (2002) Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 30:116–120PubMedGoogle Scholar
  17. 17.
    Sekiya JK, Wickwire AC, Stehle JH, Debski RE (2009) Hill-Sachs defects and repair using osteoarticular allograft transplantation: biomechanical analysis using a joint compression model. Am J Sports Med 37:2459–2466PubMedCrossRefGoogle Scholar
  18. 18.
    Kaar SG, Fening SD, Jones MH et al (2010) Effect of humeral head defect size on glenohumeral stability: a cadaveric study of simulated Hill-Sachs defects. Am J Sports Med 38:594–599PubMedCrossRefGoogle Scholar
  19. 19.
    Miniaci A, Gish MW (2004) Management of anterior glenohumeral instability associated with large Hill-Sachs defects. Techniques in shoulder & elbow surgery 5:170–175CrossRefGoogle Scholar
  20. 20.
    Grodin P, Leith J (2009) Combined large Hill-Sachs and bony Bankart lesions treated by Latarjet and partial humeral head resurfacing: a report of 2 cases. Can J Surg 52:249–254Google Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • Pradeep Kodali
  • Anthony Miniaci

There are no affiliations available

Personalised recommendations