Arthroscopic Autologous Iliac Crest Bone Augmentation for Restoring Engaging Reverse Hill‐Sachs Lesion With Anterior Capsular Tightening in Posterior Shoulder Dislocation

Abstract

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.