Knöcherne Rekonstruktionsoption bei ausgeprägter bipolarer Knochendefektsituation und anteriorer Schulterinstabilität

Patients with recurrent anteroinferior shoulder instability and bipolar bone defects often show unsatisfactory results after soft tissue stabilization alone and usually require bony augmentation. Patients with a history of epilepsy or seizures present a challenge as Hill-Sachs defects are typically very large and implant failure and complications must be anticipated in the event of recurrence. Therefore, the J‑bone graft procedure according to Resch is an elegant treatment option which prevents implant-associated complications. This patient presented with a persistent anteroinferior shoulder instability of the right shoulder after two prior failed Bankart surgeries. In addition, the patient developed instability of the left shoulder in the meantime. Therefore, both shoulders were treated with a J-bone graft and an augmentation of the Hill-Sachs defect using femoral head allografts and biocompression screws due to the bipolar bone defects. Both shoulders have not shown any recurrent dislocations since and are stable at 2‑year follow-up examination. Radiologically, there is good healing of both autograft and allograft showing remodeling. The combined glenoid and humeral augmentation with J‑bone graft and femoral head allograft is a good treatment option for patients with shoulder instability and significant bipolar bone defects. Especially in patients with questionable seizures, this glenoidal implant-free and humeral metal-free surgical option is desirable.