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Humeral head defects (Hill-Sachs lesions) are common sequelae of glenohumeral instability and potentiate recurrence. Engaging Hill-Sachs lesions clearly increase risk of recurrent instability when not addressed surgically. Arthroscopic remplissage, in conjunction with Bankart repair, has proven to be a safe and effective means to treat anterior gelnohumeral instability. Remplissage, when executed properly, favorably alters the "glenoid track" and thus lessens the risk of glenohumeral engagement in abduction external rotation. Remplissage is a biologic tissue transfer that confers much less morbidity than glenoid bone grafting procedures (Latarjet), while demonstrating comparable efficacy. [ABSTRACT FROM AUTHOR]

Intra-articular pathology that occurs from glenohumeral instability events, including labral tears, glenoid bone loss, and Hill-Sachs lesions, may contribute to increased risk of recurrent instability and persistent pain and disability following initial treatment. Careful analysis of radiographic and advanced imaging studies can assist in the recognition of clinically significant pathology. This article provides guidance on the appropriate use of diagnostic imaging for the evaluation of glenohumeral instability and describes radiographic and advanced imaging findings that can affect treatment outcomes in the contact athlete. [ABSTRACT FROM AUTHOR]

Glenohumeral bone loss and articular defects are often treated by using osseous or osteoarticular allografts. These aid in glenohumeral joint stability and in reconstruction of the native articular surface. Grafts include those such as iliac crest, coracoid, distal tibia, femoral head, or humeral head, depending on the specific surgical pathology. Articular grafts can be further subdivided into viable or nonviable sources. The outcome of grafts that are implemented for stability could be subject to osteolysis, which may portend a poor clinical outcome and recurrent instability. Similarly, grafts required for reconstruction of the articular surfacemay undergo avascular necrosis, nonunion, and collapse, rendering them useless. The status of these grafts is best assessed with postoperative imaging modalities, which range from plain film radiography to 3-dimensional computed tomography reconstructions. The purpose of this article is to review the current literature regarding the rate of graft resorption, integration, collapse, and union for each of the graftsmentioned using postoperative imaging. [ABSTRACT FROM AUTHOR]

The human shoulder is an inherently stable joint. Changes within the anatomical structure of the shoulder, both static and dynamic, allow for significant movement in multiple planes, making the shoulder one of the most commonly dislocated joints in the body. Anterior glenohumeral dislocation can result in glenoid bone loss because of fracture abrasion or the compression of the anterior inferior glenoid against the posterior lateral aspect of the humeral head known as a "Hill-Sachs" lesion. Posterior shoulder instability is a much more rare injury, whichmay result in significant bone defects of the anterior humeral head. Often, small defects are addressed by soft tissue repair, whereas larger defects may require a bony procedure, such as the use of humeral head allograft for the repair of Hill-Sachs and reverse Hill-Sachs lesions. [ABSTRACT FROM AUTHOR]

Most cases of instability of the shoulder do not involve a significant osseous lesion. Bony lesions of the glenoid and humeral head, however, can be a major cause of recurrent anterior glenohumeral instability. Unrecognized bony glenoid defects and Hill-Sachs lesions can lead to failure after arthroscopic soft tissue stabilization procedures for anterior instability. However bony defects can usually be identified and effectively treated, if an appropriate protocol and workup is followed. Current indications for the treatment of anterior glenohumeral instability with a bony augmentation procedure include anteroinferior glenoid bone loss of greater than 20%-30%, an engaging Hill-Sachs lesion, or an Instability Severity Index Score greater than 6. A variety of procedures have been described for treating bony instability, including both arthroscopic and open techniques. Here we discuss the evaluation, workup, and treatment of anterior shoulder instability related to bone deficiency of the glenohumeral joint. [ABSTRACT FROM AUTHOR]

Following a traumatic anterior shoulder dislocation, the treating physician is challenged not only with management of this injury extremely but also with the goal of preventing recurrent instability episodes. Although arthroscopic Bankart repair has been shown to significantly decrease the prevalence of recurrent instability, some patients remain significantly at risk for failed operative management owing to the presence of anterior glenoid and posterior humeral head bony loss that may remain unrecognized or unaddressed at the time of surgical intervention. In patients with these posterior-lateral humeral head defects (Hill-Sachs lesions), arthroscopic posterior capsulotenodesis, or remplissage, is an arthroscopic procedure that can be used to supplement arthroscopic Bankart repair. The remplissage procedure offers an effective and valuable technique for some patients with Hill-Sachs lesions and has been demonstrated to reduce the risk of recurrent instability. [ABSTRACT FROM AUTHOR]