Ream and run - posteriorly eccentric head to manage anterior subluxation

A very physically active man in his mid forties presented to us with pain in the left shoulder after a prior instability repair. His x-rays showed some degenerative changes and anterior position of the humeral contact point on the glenoid.

He strongly desired a ream and run procedure.
At surgery his humeral head showed a full-thickness cartilage defect occupying the central aspect of the joint surface - worse than might have been expected from the preoperative x-rays.

 He had a ream and run procedure

To manage the tendency for anterior subluxation, we used a posteriorly eccentric humeral head as shown on his axillary view.

On his first postoperative day he attained 150 degrees of assisted flexion without any sensation of instability.

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