Outcomes following arthroscopic treatment of off-track Hill-Sachs lesions using fresh osteochondral allograft plugs: a case series

• Published in: Journal of shoulder and elbow surgery
• Main Authors: George, Andrew, Kraeutler, Matthew J., Lintner, David M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 02.08.2024
• Subjects: arthroscopy; Hill-Sachs; OCA plugs; osteochondral allograft; outcomes; Shoulder instability; Treatment Study; Shoulder instability; Level IV; osteochondral allograft; outcomes; Case Series; Hill-Sachs; OCA plugs; arthroscopy
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2024.06.008

Osteochondral allograft (OCA) transplantation is a well-described technique for the treatment of large, engaging Hill-Sachs lesions (HSLs). Traditionally, OCAs are size-matched to the defect, which can be expensive and time-consuming, and the majority of described techniques require an open approach. Recently, an all-arthroscopic approach to Hill-Sachs OCA transplantation using premade plugs was described, eliminating the need for size-matching and graft harvest. The purpose of this study was to evaluate postoperative outcomes of patients who have undergone arthroscopic treatment of HSLs using premade OCA plugs. We hypothesized that these patients would have improved pain and function without recurrent instability. A retrospective chart review was performed using operative reports for a single surgeon with search terms Hill-Sachs and allograft. Patients were excluded if an open approach was used or if graft harvest was performed. Postoperative imaging was reviewed to assess for graft incorporation and reconstitution of the HSL. Recurrent instability and reoperation were recorded. Patients completed surveys including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Five patients were identified through chart review and met inclusion criteria. All patients underwent concurrent labral repair and 2 patients underwent a concurrent open Latarjet procedure. Postoperative radiographs showed reconstitution of the HSLs in all patients. There were no complications in the postoperative period with no recurrent instability or reoperations in any patient. The average ASES score was 87% (higher score indicating better outcome) with standard deviation 9.7, and the average WOSI score was 27% (lower score indicating better outcome) with standard deviation 8.3. Favorable outcomes can be expected after arthroscopic treatment of Hill-Sachs lesions using premade OCA plugs. Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches.