Arthroscopic Bone Grafting of the Humeral Head for Treatment of a Deep Hill-Sachs Lesion

Recurrent anterior shoulder dislocation often leads to the presence of a Hill-Sachs lesion. A large Hill-Sachs lesion compromises shoulder stability and should be addressed with bone augmentation when it is too deep. Here, we introduce a method of arthroscopic bone grafting of the humeral head for the treatment of a deep Hill-Sachs lesion in patients with anterior shoulder instability. Our indication for this procedure is a deep off-track Hill-Sachs lesion measuring at least 8 mm in depth and 10 mm in width. The main steps of this procedure include graft placement via special shoulder bone grafting instruments, graft suspension fixation using suture anchors, and bone fragment compression using the infraspinatus tendon. We routinely use this technique in combined treatment procedures for complicated anterior shoulder instability.