Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: A retrospective clinical study of 13 cases

Abstract

ObjectiveThis study aimed to present middle-term functional and radiological outcomes of the transfer of the lesser tuberosity in the management of reverse Hill-Sachs lesions following posterior dislocations of the shoulder.Patients and methodsWith a diagnosis of neglected posterior shoulder dislocation (8 locked, 5 recurrent), 13 male patients (age range: 28–72; mean age: 39.3 years) who underwent the transfer of the lesser tuberosity due to reverse Hill-Sachs lesions, were retrospectively reviewed based on functional and radiological data. The etiologies were: epilepsy in 9 patients, a traffic accident in 2 patients, and fall in 2 patients. To assess the patients' functional level, American Shoulder and Elbow Surgeons (ASES) and Constant Scores were used, and the patients' range of motion at the last follow-up was measured. To evaluate the development of arthrosis, the final follow-up control plain radiographs were examined. The average size of the defects calculated from the axial computed tomography sets was 27% (range: 20%–40%).ResultsThe average length of follow-up was 30 months (range: 12–67 months). At the last follow-up visit, the main ASES and Constant Scores were 78 and 85, respectively, and the average degrees of flexion, abduction, and external rotation were 163°, 151°, and 70° respectively. The concentric reduction was observed postoperatively.ConclusionMcLaughlin procedure appears to be a safe and effective method in the treatment of neglected posterior shoulder dislocations with reverse Hill-Sachs lesion.Level of EvidenceLevel IV, Therapeutic study.

All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill–Sachs Lesion Caused by Locked Posterior Shoulder Dislocation

“…In another study, Demirel et al investigated the middle-term functional and radiological outcomes of the transfer of the lesser tuberosity in the management of reverse Hill–Sachs lesions following posterior dislocations of the shoulder. 31 They reported satisfactory results at the last follow-up of 13 patients treated in an open manner. In a case report of a young male athlete with neglected locked posterior shoulder dislocation combined with reverse Hill–Sachs lesion, Steckel et al illustrated excellent clinical, functional, and radiological outcome after open modified McLaughlin's procedure 32 Finally, in another case report, Charalambous et al described a modification of the open repair through deltopectoral approach and plication of the subscapularis tendon into the reverse Hill–Sachs lesion via two-bone anchors.…”

Posterior shoulder dislocation with reverse Hill-Sachs lesion. A technical note and report of two cases

“…It is reported that performing a modified McLaughlin procedure is enough [ 13 , 14 ]. They reported good results, in terms of joint stability, simply eliminating shoulder internal rotation postoperatively, with the use of either in an abduction brace and neutral rotation or in an external rotation brace [ 13 , 14 ]. However, if joint stability and posterior labrum pathology are not addressed intraoperatively, the joint stability postoperatively relies mostly on the patient’s compliance to a shoulder brace avoiding internal rotation.…”

“…Non-operative treatment is an option ("supervised neglect"), especially in low-demand elderly patients with concomitant comorbidities, however, in the vast majority of the patients (the young and active ones as most of them are) various operative options have been suggested [11]. A reverse Hill-Sachs lesion with impaction of more than 20-40% of the humeral head articular surface and symptoms of posterior instability or pain, usually needs to be addressed surgically [12][13][14]. Bone disimpaction and fracture fixation, reconstruction with muscle-tendon transfer (McLaughlin procedure or a modified technique), rotational osteotomy, humeral bone augmentation (using autograft, allograft, or a synthetic substitute), arthroscopy and posterior Bankart repair or even joint arthroplasty, are all viable options in the acute phase, depending on the various clinical and radiological parameters [11,[15][16][17][18].…”

Arthroscopic McLaughlin Procedure for Treatment of Posterior Instability of the Shoulder With an Engaging Reverse Hill-Sachs Lesion

“…With 58% of capsulolabral lesions and 28% of engaging RHSLs, 12 posterior shoulder dislocation often leads to posterior instability. Most studies on the treatment of RHSLs are Technical Note,8, 9, 10 and only a few have evaluated outcomes3, 13; none have evaluated the outcomes of arthroscopic remplissage of the defect.…”