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March 01, 2013
Contributors: John Morton, MD; Ed Bateman, MD; Ed Bateman, MD
Keywords: Bony Procedure
Large engaging Hill-Sachs lesions are known to contribute to the failure rate of a Bankart repair. Anterior glenoid bone loss in instability can be treated successfully with a Latarjet or Bristow procedure. The problem is how to treat a large Hill-Sachs lesion when there is no glenoid bone loss. Currently there are non-anatomical options. One is the remplissage procedure, which has proven useful for tenodesing the posterior cuff into the Hill-Sachs defect. This procedure has a well-described discomfort rate associated with posterior capsular tightness. Another non-anatomical treatment is the Latarjet procedure, which raises questions about correcting the glenoid for a humeral problem. Dr. Bateman demonstrates the assessment and indications for treatment of Hill-Sachs lesions as well as an arthroscopic technique for inserting HemiCAPs® into Hill-Sachs lesions to improve humeral congruity and reduce the failure of Bankart repairs. He also demonstrates "stacking" of HemiCAPs® for more elongated lesions and explains when to combine this procedure with bony glenoid procedures. To date, Dr. Bateman and his team have used HemiCAPs® with 25 patients for 5 years. The arthroscopic technique has been used for 18 months with 2 traumatic failures, which were converted successfully to Latarjet procedures. So far, there have been no complications from the implants in terms of loosening, pain, or infection. Mid-term results are currently under review with publication expected in 2013.