Arthroscopic Transfer of the Subscapularis Tendon for Treatment of a Reverse Hill-Sachs Lesion

Posterior shoulder instability occurs less often than anterior shoulder instability but is increasingly recognized as a relatively common condition. The reverse Hill-Sachs lesion is present in some patients with posterior instability and is best described as an impaction fracture of the anterior humeral head. These reverse Hill-Sachs lesions can predispose the patient to recurrent instability events and may need to be addressed directly at the time of surgery. Multiple open and arthroscopic procedures have been described to transfer bone or soft tissue structures into this reverse Hill-Sachs defect. An arthroscopic technique for the transfer of the subscapularis tendon into the defect using a standard 30° arthroscope, standard portals, and suture anchors is described.