Hill–Sachs lesions are best treated with a surface replacement—Opposes

A Hill-Sachs lesion (HSL) is an impression fracture that is typically located in the posterior superolateral location on the humeral head and is a tell tale sign of anterior shoulder dislocation. Hill-Sach lesions are a common associated pathoanatomic finding in anterior shoulder instability but a large, clinically significant HSL is uncommon. The management of a large HSL is a challenging clinical situation in a young patient. The first priority is repair of anterioinferior capsulolabral soft tissues and restoration of glenoid arc to increase the glenoid track and this option alone is effective in most of the patients. A large HSL in presence of bipolar bone loss may require surgical management to prevent engagement. Anatomic restoration of the humeral head defect with a fresh humeral head osteochondral allograft provides anatomic stability and biology (live cartilage cells) and is a viable option for treatment of large HSL. We reserve prosthetic option (arthroplasty) for elderly patients with large HSLs or as a salvage option for failed allograft reconstruction of HSL in young patient with arthritis.