Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder Instability (original) (raw)
2021, Arthroscopy Techniques
Posterior shoulder dislocations are an uncommon cause of glenohumeral instability; they are frequently missed and are associated with humeral head defects and capsulolabral lesions. Despite surgical treatment often being mandatory, there is still no standardized treatment for anterior impaction fractures of the humeral head (reverse Hill-Sachs lesions). Arthroscopic surgery is typically indicated, with a tendency toward resorting to knotless techniques in recent years. We present a method for the treatment of posterior shoulder dislocations with engaging reverse Hill-Sachs lesions that achieves full defect coverage using an arthroscopic all-in-the-box knotless subscapularis bridge technique with 2 anchorsdwith one crossing the subscapularis tendon and the other embracing itdalong with posterior capsulolabral complex restoration. This promising technique is a potentially superior alternative for the treatment of these lesions that can also be used in the presence of concomitant partial subscapularis tears. Preoperative Evaluation and Indications Post-traumatic shoulder dislocations with recurrent episodes of atraumatic posterior subluxation caused by From the Shoulder Unit,
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BMC musculoskeletal disorders, 2017
The current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we also aimed to present long term results followed for a minimum of five years. This study is a prospective case series of 17 patients who were treated in our clinic between 2008 and 2011. Patients with a defect size smaller than 25% of the articular surface were treated conservatively. An endoprosthesis of the glenohumeral joint was implanted in patients with a defect size bigger than 40%. All remaining patients were treated by a variety of operative techniques, depending on the quality of the bone and size of the defect. Twelve of seventeen patients had a defect size of the humeral articular surface between 25% and 40% with a mean age of 39 years. Depending on the defect size these patients were treated with retrograde chondral elevation, antegrade cylindrical graft or a graft of the iliac bone crest with an open approach. All the proc...
Arthroscopy Techniques
Posterior shoulder dislocation is associated with an engaging reverse Hill-Sachs lesion (i.e., involving >25% of the articular surface of the humeral head) in 28% of cases, leading to posterior instability. Isolated capsulolabral fixation usually performed to treat posterior instability is not effective at stabilizing the shoulder when there is such a bony lesion. The original McLaughlin procedure, first described in 1952, consists of detaching the subscapularis tendon from the lesser tuberosity and transferring it to the bony defect by an open approach. Several open and arthroscopic modifications of this technique have been described since this description. This article describes a truly arthroscopic McLaughlin procedure. Arthroscopy allows complete visualization of the glenohumeral joint and allows associated posterior and anterior soft-tissue lesions to be addressed at the same time. Moreover, the morbidity of open procedures is avoided. Although this procedure is known to be effective at stabilizing the shoulder, further long-term studies are required to assess the functional outcomes.
Eur J Orthop Surg Traumatol, 2016
Abstract Background Among the uncommon and frequently missed orthopedics injuries is the posterior shoulder dislocation, accounting for about 2–4 % of all shoulder dislocations. Commonly, it is associated with the well-known reverse Hill–Sachs lesion. Several surgical treatment modalities such as transfer of subscapularis tendon or lesser tuberosity, humeral rotational osteotomy, osteochondral grafts were used to repair this defect. Hemiarthroplasty or total shoulder arthroplasty was used as salvage procedure in non-constructable defect or neglected old dislocation. Patients and methods This study included 11 patients with locked chronic posterior shoulder dislocation and reverse Hill–Sachs defects falling in the target range (25–50 % of the head size). The mean age of the patients was 39 (range 31–49) years. Mean time from injury to surgery was 9 (range 3–18) weeks. Open reduction in the dislocated head with the transfer of subscapularis tendon and the attached lesser tuberosity was done to reconstruct the reverse Hill– Sachs defect. The transferred tuberosity was fixed with size 5 Ethibond sutures. Results The mean follow-up period was 29 (range 24–39) months. The median of the scores was much improved, reaching 30 (range 20–34) (satisfactory) compared with preoperative median of 24 (range 20–25) (unsatisfactory). This was statistically highly significant (P = 0.002). Postoperatively, 9 patients had no pain or restricted daily living activities. No patient had symptoms of shoulder instability. According to the modified UCLA shoulder rating scale, there were 4 patients rated excellent, 5 patients rated good, one patient rated fair and one patient rated poor. Conclusion Reconstructing the reverse Hill–Sachs defect provides adequate stability, pain relief and function in patients with locked chronic posterior shoulder dislocation and a defect involving 25–50 % of the humeral head. The used technique is simple and cost effective with no need for subsequent hardware removal. Level of evidence II. Keywords Reconstruction ! Reverse Hill–Sachs lesion ! Locked chronic posterior shoulder dislocation
HSS Journal ®, 2014
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Hill-Sachs Remplissage Procedure and its Role in Arthroscopic Stabilisation of the Shoulder
International Journal of Orthopaedics, 2021
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Recurrent anterior shoulder dislocation with engaging Hill–Sachs defect: remplissage or Latarjet?
European Orthopaedics and Traumatology, 2015
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Journal of Medical Cases, 2012
Posterior dislocations of the humeral head are rare and often missed on initial presentation. Half of these injuries are associated with an impression fracture of the anteromedial aspect of the humeral head (reverse Hill-Sachs lesion). Several operative strategies have been described to treat this injury, but evidence based management strategies are lacking. We describe a case in which a young and active patient presented with a stiff and painful shoulder following a clavicle fracture 9 months earlier. MRI revealed a locked posterior shoulder dislocation and large reverse Hill-Sachs defect. Anatomic reconstruction of the humeral head was performed using a femoral head allograft to fill the defect. A year later the patient has a good shoulder function without pain or impairments in his daily activities. Posterior shoulder dislocation continues to be a "diagnostic trap". This case reinforces the importance of radiographic axial and transscapular (Y) shoulder views to prevent missing the diagnosis. We state that, even in cases with delayed diagnosis and large humeral head defects, one should attempt to preserve the stability and function of the shoulder joint by restoring the normal anatomy of the humeral head. Femoral head allografting proves to be a suitable option. This case is unique in the combination of injuries, the long diagnostic delay and the encouraging functional results after femoral head allografting.
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