Lemon Wedge Humeral Head Allograft Reconstruction Technique for Large Reverse Hill-Sachs Lesion

Reverse Hill-Sachs lesions (RHSLs) are compression fractures of the anteromedial humeral head that occur with posterior shoulder dislocations, often contributing to recurrent instability and failure of isolated posterior labral repair. Surgical intervention is indicated for large, engaging lesions to restore bone density and prevent recurrent dislocation.

Lemon wedge humeral head allograft reconstruction is a novel technique used for instances of recurrent posterior shoulder instability resulting in a large RHSL.

Arthroscopic evaluation is used to verify a detached posterior labrum and a large RHSL of the anteromedial humeral head. Posterior labral repair is performed with mobilization, debridement, and fixation using 3 knotless suture anchors, restoring the capsulolabral complex to achieve stable reattachment. Next, attention is turned to the RHSL. Through a deltopectoral approach, the subscapularis tendon is tenotomized for exposure, and the lesion is excised in a wedge fashion. A fresh humeral head allograft, precisely shaped using a wax mold, is press-fit into the defect and stabilized with headless compression screws buried beneath the articular surface. Finally, the subscapularis is repaired to cover the reconstruction and restore anterior stability, completing the combined arthroscopic labral repair and open humeral head allograft transplantation.

Postoperative imaging confirmed congruent reduction and stable allograft fixation. Rehabilitation was staged with progressive motion, strengthening, and functional recovery, with return to activity anticipated after 6 months.

RHSLs associated with recurrent posterior instability require careful surgical management. The lemon-wedge humeral head allograft technique provides anatomic reconstruction of the humeral head and restores posterior stability, offering a joint-preserving alternative to arthroplasty in active patients. While technically demanding and biologically limited by graft availability, this approach represents a viable option for managing large RHSLs. The literature suggests that osteochondral allograft transplantation provides favorable outcomes in terms of stability and function. However, long-term complications such as graft resorption, arthritis, and conversion to arthroplasty remain possible. Further studies with long-term follow-up are needed to refine patient selection and optimize surgical outcomes.

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