Arthroscopic Humeroplasty in the Treatment of Acute Reverse Hill-Sachs Lesion Associated With Posterior Shoulder Instability

Reverse Hill-Sachs lesions (RHSL) are common complications associated with posterior shoulder dislocations and represent a significant challenge for preserving joint stability and function. If untreated, these compression fractures of the anteromedial humeral head can compromise the integrity of the joint, predisposing patients to recurrent instability and arthropathy. While various treatment modalities exist, achieving an anatomic reduction of the defect while preserving the articular cartilage remains a desirable outcome, particularly in acute settings. This case report describes the successful application of a minimally invasive arthroscopy and fluoroscopy-assisted ballon humeroplasty technique to treat an acute RHSL in a 26-year-old male with bilateral posterior shoulder dislocations following trauma. While one shoulder was managed conservatively, the other exhibited recurrent instability due to an engaging RHSL, which led to surgical intervention. The procedure employed a ballon system to disimpact the humeral defect and subsequent filling with a calcium phosphate bone substitute. The procedure achieved near-anatomic reconstruction of the humeral head without compromising the integrity of the surrounding articular cartilage. At two years of follow-ups, the patient reported no instability or pain, regained full functional capacity, and achieved excellent outcomes, as demonstrated by high shoulder performance scores. This report highlights a minimally invasive technique that appears promising as a safe, effective, and reliable anatomic treatment for acute RHSL while preserving cartilage.