Arthroscopic Autologous Iliac Crest Bone Augmentation for Restoring Engaging Reverse Hill-Sachs Lesion With Anterior...

Posterior shoulder dislocation is often accompanied by a reverse Hill-Sachs lesion that may engage the posterior glenoid rim and drive recurrent instability. Lesions involving >25% of the humeral articular surface frequently require surgery. We describe an all-arthroscopic, joint-preserving technique that combines humeral reconstruction with posterior stabilization. A curved iliac-crest corticocancellous bone block is inlaid to restore the humeral defect and fixed with suture anchors using a double-pulley compression construct. Anterior capsular soft-tissue compression is added extra-articularly to augment stability. In the same setting, the posterior labrum-capsuloligamentous complex is repaired with suture anchors to re-establish glenoid containment. This single-stage approach addresses both bony and soft-tissue pathology to prevent engagement and preserve native joint function.