Use of Autogenous Tricorticocancellous Iliac Crest Graft for Large Hill–Sachs Lesion Associated with Anterior Glenohumeral Dislocation: A Case Report

INTRODUCTION: Although Hill–Sachs lesions are frequently associated with recurrent anterior glenohumeral dislocation, understanding of biomechanics and the importance of having an engaging or non-engaging lesion has only been recently studied at more depth. It is now widely accepted that engaging lesions benefit from surgery due to the high risk of symptom recurrence if left untreated. Techniques that have been described include capsular shift procedures, rotational osteotomies of the humeral head, or even femoral or humeral head allografts. The authors describe an alternative treatment which involves autogenous tricorticocancellous iliac crest graft to treat the bony defect in a patient with recurrent anterior glenohumeral dislocation and a large, engaging Hill–Sachs lesion. CASE REPORT: A 33-year-old male with clinical history of two anterior-inferior dislocations of the left shoulder presented with chronic instability and a large Hill–Sachs defect (about 30% of the humeral head) with an anterior labrum lesion but no glenoid bony lesion. The defect was treated with a tailored autogenous tricorticocancellous iliac crest graft and fixed with headless compression screws. The patient returned to every-day activities at 5 months postoperatively and has a complete range of motion no complications were observed. CONCLUSION: This appears to be a safe and painless technique with excellent functional results, that should, however, be validated in the future with prospective randomized controlled trials.