Fresh Talus Allograft Preparation for the Treatment of a Large Off-Track Hill-Sachs Lesion

Large off-track Hill-Sachs lesions present a significant challenge in the management of recurrent anterior shoulder instability, particularly in young, active patients. Traditional Hill-Sachs management procedures include remplissage, coracoid transfer and free bone block reconstruction, which all carry associated limitations, including non-anatomic reconstruction, donor-site morbidity, risk of resorption, and/or glenohumeral contour mismatch, in addition to the risk of insufficient restoration of the glenoid track in the setting of a large off-track Hill-Sachs lesion. The fresh talus allograft free bone block has recently emerged as an excellent alternative source for a Hill-Sachs lesion, given its close anthropometric match to the humeral head, robust articular cartilage, and variable graft sizing options. The purpose of this Technical Note is to describe a detailed, reproducible technique for the preparation of a fresh talus osteochondral allograft for reconstruction of a large off-track Hill-Sachs lesion.