Posterior Glenohumeral Capsular Reconstruction With Modified McLaughlin for Chronic Locked Posterior Dislocation

Abstract

Posterior instability is relatively rare when compared with anterior instability but can comprise up to 40% of operatively treated instability cases. Posterior dislocations are much rarer and are classically due to trauma, seizure, or electric shock. Due to a lack of an obvious deformity and an internally rotated and adducted arm position, posterior shoulder dislocations often are missed on initial presentation. In the management of posterior dislocations, considerations need to be made in regard to bony and soft-tissue pathology. In the setting of soft-tissue deficiency, previous options included nonoperative management primarily consisting of bracing and activity modification as well as arthroplasty options that do not rely on the capsulolabral complex for stability. In this paper, we present a technique for treating a chronic posterior shoulder dislocation with an associated large reverse Hill–Sachs deformity. In this setting, a revision labral repair and capsulodesis is generally not possible due to insufficient capsulolabral tissues. Here, we present the technique for an arthroscopic posterior capsule reconstruction using an acellular dermal allograft as well as a McLaughlin procedure for the treatment of a reverse Hill–Sachs lesion.

Arthroscopic Reduction of a Chronic Locked Posterior Shoulder Dislocation

“…Matthewson and Wong 6 introduced a purely arthroscopic surgical procedure for a chronic locked posterior shoulder dislocation. In their report, the glenohumeral joint could be accessed through a routine posterior portal.…”

“…However, for a chronic posterior shoulder dislocation, which usually appears in a locked status, a medial-to-lateral reduction and anterior-to-posterior soft-tissue balance are difficult to realize. 5 , 6 We consider the capsule-muscle contracture and adhesion to be the main mechanisms that impede the lateralization of the humeral head and consider the rotator interval contracture, scar formation around the subscapularis, and obstruction of the biceps to be the main mechanisms of anterior-posterior imbalance. Thus, we have developed a special arthroscopic shoulder release and reduction technique to address all these pathologic changes.…”

Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity

“…For cases of chronic locked posterior GH dislocation, Matthewson et al described an arthroscopic technique of posterior GH capsular augmentation using a dermal allograft as well as McLaughlin reconstruction of reverse Hill-Sachs defect, pointing out that despite closed reduction of the GH joint was feasible prior to reconstruction; however, capsular augmentation was technically demanding due to posterior GH scarring and graft tangling. In accordance, Mitchel et al introduced an arthroscopic repair technique of posterior gleno-humeral ligament/labrum avulsion prior to reconstruction of Hill-Sachs defect using fresh talar osteo-chondral allograft, emphasizing the necessity of addressing posterior capsular lesions encountered in chronic posterior GH dislocation to avoid postoperative persistence of posterior GH instability [11,21,22].…”