Background <p>Posterior shoulder dislocation accompanied by reverse Hill-Sachs lesions is relatively rare, whereas bilateral posterior shoulder dislocation is exceedingly rare.</p> Case presentation <p>We report two cases of bilateral posterior shoulder dislocations associated with reverse Hill-Sachs lesions. In Case 1, the lesions were managed using the McLaughlin procedure and the modified McLaughlin procedure. In Case 2, open reduction and internal fixation of the left shoulder was unsuccessful; consequently, reconstruction of the right humeral head was performed using bone cement.</p> Conclusions <p>Bilateral posterior shoulder dislocations with reverse Hill-Sachs lesions are uncommon and are therefore prone to misdiagnosis. Early recognition and appropriately selected treatment strategies, tailored to the severity of the injury, are essential to achieve satisfactory functional outcomes. For severely comminuted proximal humeral fractures, when internal fixation is not feasible and no joint replacement prostheses are unavailable, bone cement reconstruction may serve as a reasonable alternative.</p>