Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder Instability

Abstract

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 IndicationsPost-traumatic shoulder dislocations with recurrent episodes of atraumatic posterior subluxation caused by From the Shoulder Unit,

Arthroscopic Modified McLaughlin Procedure and Remplissage for Treatment of Simultaneous Reverse Hill-Sachs and Hill-Sachs Lesions

“…4 On the other hand, a great number of techniques have been described to treat RHSLs. 5 Historically, most of the current treatments for posterior shoulder instability were based on the humeral head defect size. However, consensus on a specific treatment is yet to be established.…”

“…Since then, variations in location and number of suture anchors, suture configuration, or use of the medial glenohumeral ligament instead of the subscapularis tendon have been proposed. 2,5,[8][9][10]16 The technical note we present uses portals, equipment, and suture management methods that are very familiar to the arthroscopic shoulder surgeon and can be reliably performed.…”

“…4 On the other hand, a great number of techniques have been described to treat RHSLs, and consensus on a specific treatment is yet to be established. 5 McLaughlin, 6 in 1952, described his technique involving the transfer of the subscapularis tendon into the anterior humeral defect. Afterward, Krackhardt et al 7 proposed the first all-arthroscopic technique based on fixation of the subscapularis tendon into the RHSL, commonly known as "reverse remplissage."…”

“…Since then, many variations of this arthroscopic procedure have been proposed. 5,[8][9][10] In this article, we propose a method of treatment for combined simultaneous HSL and RHSL shoulder injuries. The purpose of this Technical Note is to show an arthroscopic treatment guideline for patients with shoulder instability due to anterior and posterior labral lesions, HSL, and RHSL.…”

Comprehensive management of posterior shoulder instability: diagnosis, indications, and technique for arthroscopic bone block augmentation

“…Multiple surgical techniques for the treatment of recurring posterior instability have been described in the last decades (7). Currently, treatment strategies are focused on soft tissue repair, with capsulolabral reconstruction to restore the glenoid concavity and the posterior bumper effect, with or without reverse remplissage to address reverse Hill-Sachs lesions, having good clinical results in the absence of glenoid defects (8,9). The presence of traumatic or erosive glenoid bone defects, a dysplastic glenoid rim, and a thin posterior capsule has increased the use of techniques with a bone graft (10,11,12,13,14).…”