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Boulet J, Pelet S, Matache BA. Arthroscopic Subdeltoid Humeroplasty in the Beach-Chair Position for Reverse Hill-Sachs Lesions. Arthrosc Tech 2024; 13:102973. [PMID: 39036406 PMCID: PMC11258852 DOI: 10.1016/j.eats.2024.102973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2024] [Indexed: 07/23/2024] Open
Abstract
Reverse Hill-Sachs lesions (HSLs) often involve a greater percentage of the humeral head articular surface than posterior HSLs and frequently require surgical treatment in the setting of posterior shoulder instability. Multiple techniques have been described to treat these lesions depending on their size, acuity, and location. The (modified) McLaughlin procedure is widely used to treat smaller engaging lesions, whereas larger lesions involving a greater percentage of the humeral head articular surface require anatomic disimpaction, termed "humeroplasty." Humeroplasty is traditionally performed via an open approach. This technical note describes an arthroscopic subdeltoid humeroplasty technique for the reduction and fixation of reverse HSLs in the beach-chair position.
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Affiliation(s)
| | - Stéphane Pelet
- Université Laval, Québec, Canada
- Division of Orthopaedic Surgery, Department of Surgery, CHU de Québec, Québec, Canada
| | - Bogdan A. Matache
- Université Laval, Québec, Canada
- Division of Orthopaedic Surgery, Department of Surgery, CHU de Québec, Québec, Canada
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2
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Smith WR, Edwards TB. Posterior Shoulder Instability and Glenoid Bone Loss: A Review and a Free Bone Graft Technique. J Clin Med 2024; 13:2016. [PMID: 38610781 PMCID: PMC11012477 DOI: 10.3390/jcm13072016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate in activities that repetitively stress the posterior stabilizing structures of the shoulder are more prone to developing posterior shoulder instability. A variety of surgical options have been described, ranging from isolated capsulolabral repair to glenoid osteotomy. Soft-tissue repair alone may be an inadequate treatment in cases of pGBL and places patients at a high risk of recurrence. Our preferred technique for posterior glenoid reconstruction in cases of pGBL involves the transfer of a free iliac crest bone graft onto the native glenoid. The graft is contoured to fit the osseous defect and secured to provide an extension of the glenoid track. In this study, we review pGBL in the setting of posterior instability and describe our technique in detail. Further long-term studies are needed to refine the indications for glenoid bone graft procedures and quantify what constitutes a critical pGBL.
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Affiliation(s)
| | - T. Bradley Edwards
- Fondren Orthopedic Group, Fondren Orthopedic Research Institute, Texas Orthopedic Hospital, Houston, TX 77030, USA;
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Hu Y, Yang K, Liu H, Wang L, Wang S, Zhang X, Qu B, Yang H. 3D-printed custom implant for the management of "locked" posterior dislocation of the shoulder joint with reverse Hill-Sachs lesion: a case report. Front Bioeng Biotechnol 2023; 11:1259255. [PMID: 37877040 PMCID: PMC10590887 DOI: 10.3389/fbioe.2023.1259255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction: Irregular bone defects of the humerus are common in clinical practice, but there are fewer reported cases of irregular humeral defects accompanied by shoulder joint "locking" dislocation and reverse Hill-Sachs injury caused by an electric shock. The choice of treatment for such cases is closely related to the extent of shoulder joint function recovery. This is a case report of a 60-year-old male patient who suffered from a shoulder joint "locking" dislocation with accompanying reverse Hill-Sachs injury due to muscle contraction after being electrically shocked at work. The patient was treated with a 3D-printed custom humeral head prosthesis for the treatment of the shoulder joint "locking" dislocation and reverse Hill-Sachs injury. Case presentation: A 60-year-old male patient, working as a construction worker, presented to our emergency department with right shoulder pain and restricted movement for more than 30 min after an electric shock. Right humeral CT revealed a comminuted fracture of the right humeral head. D-dimer levels were significantly elevated at 3239.00 ng/mL, and oxygen partial pressure was slightly decreased at 68 mmHg. Treatment included emergency wound debridement and dressing for the electrical injury, cardioprotective measures, anticoagulation, and symptomatic management. After stabilizing the patient's condition, the patient underwent 3D-printed custom prosthesis-assisted partial replacement of the right humeral head and rotator cuff repair in the orthopedic department. Postoperatively, the patient's right shoulder joint wound healed well, and mobility was restored. Conclusion: This case report demonstrates that the use of a 3D-printed custom prosthesis for the treatment of irregular humeral bone defects caused by specific injury mechanisms, especially cases involving shoulder joint "locking" dislocation and reverse Hill-Sachs injury, can achieve precise bone defect repair, minimize surgical trauma, and provide superior outcomes in terms of postoperative functional rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | - Bo Qu
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
| | - Hongsheng Yang
- Department of Orthopedics, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan Province, China
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4
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Xiong F, Yin Q, Wang J, Wei C, Gu S, Liu Y. A novel modified McLaughlin surgery for treating locked chronic posterior shoulder dislocation. BMC Musculoskelet Disord 2023; 24:114. [PMID: 36765319 PMCID: PMC9921029 DOI: 10.1186/s12891-023-06221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Posterior shoulder dislocation is an uncommon orthopaedics injury and is frequently missed or misdiagnosed, accounting for 2%-4% of all shoulder dislocations, and is associated with the reverse Hill-Sachs lesion. Once posterior shoulder dislocation develops into a chronic disease, it will bring a lot of trouble to the treatment, especially in repairing the humeral defects. Surgical strategies are also developing and innovating to deal with this injury, including transfer of subscapularis tendon or lesser tubercle, humeral rotational osteotomy, autogenous bone graft or allograft. Shoulder replacement seems to be the ultimate and only option when the injury becomes irreparable, although some studies have shown unsatisfactory follow-up results. Considering no gold-standard treatment for locked posterior shoulder dislocation, we described a novel modified McLaughlin procedure for locked chronic posterior shoulder dislocation and evaluated the functional outcomes. METHODS This study included five locked chronic posterior shoulder dislocation patients with an associated reverse Hill-Sachs lesion, in which the compression surface covered 30-40% of the humeral head. The mean period from injury to receiving surgery was 11.6 weeks (6-24 weeks). All five patients underwent the modified McLaughlin procedure, mainly divided into three steps, including open reduction, transfer of the partial lesser tuberosity and artificial bone to repair the reverse Hill-Sachs defects. The kernel technique was to fix the transferred tuberosity with two lag screws and strengthen it with two Ethibond sutures. The Constant-Murley score (CMS), the range of shoulder motion and the complications were recorded to assess and compare the functional situation of the shoulder postoperatively and postoperatively. RESULTS After an average of 19.8 months (12-30) of follow-up, the mean CMS improved to 85.8 ± 4.9 (79-91) compared with 46.0 ± 4.5 (40-52) preoperatively, which showed a significant difference (p = 0.001). In the final follow-up, all five patients showed no symptoms of shoulder instability, and there was no pain or limited activity in daily life, thus all patients were satisfied with the results. CONCLUSION Repairing the reverse Hill-Sachs lesion by transferring the partial lesser tuberosity combined with artificial bone fixed by lag screws and sutures can ensure shoulder stability and provide pain relief and good function in patients with locked chronic posterior shoulder dislocation associated with the humeral head defect.
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Affiliation(s)
- Fei Xiong
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China ,grid.263761.70000 0001 0198 0694Orthopaedic Institute, Medical College, Soochow University, NO.178 Ganjiang East Road, Suzhou, China
| | - Qin Yin
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Jian Wang
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Changbao Wei
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Sanjun Gu
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Yu Liu
- Department of Orthopaedics, Wuxi 9Th People's Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China.
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5
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Shevate I, Salunkhe R, Kulkarni K, Janapamala K, Deshmukh A. A Case of Modified McLaughlin Procedure in Neglected Posterior Shoulder Fracture Dislocation. Cureus 2023; 15:e34356. [PMID: 36874667 PMCID: PMC9974937 DOI: 10.7759/cureus.34356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.
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Affiliation(s)
- Ishan Shevate
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Rahul Salunkhe
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ketan Kulkarni
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Kishore Janapamala
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ashwin Deshmukh
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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6
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Bryant JD, Caldwell PE, Pearson SE. The "BioHumi" Humeral Head Osteochondral Allograft Transplantation for Reverse Hill-Sachs Lesion of the Shoulder. Arthrosc Tech 2022; 12:e107-e114. [PMID: 36814973 PMCID: PMC9939741 DOI: 10.1016/j.eats.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 12/24/2022] Open
Abstract
Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the "BioHumi" technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft.
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Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell III, M.D., 1501 Maple Ave., Suite 200 Richmond, VA 23226, U.S.A..
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7
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Arauz S, González-Martín D, Quiroga M, Guillén P. Arthroscopic Modified McLaughlin Procedure and Remplissage for Treatment of Simultaneous Reverse Hill-Sachs and Hill-Sachs Lesions. Arthrosc Tech 2022; 11:e1473-e1478. [PMID: 36061462 PMCID: PMC9437510 DOI: 10.1016/j.eats.2022.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023] Open
Abstract
Hill-Sachs lesions (HSLs) can be present after a primary shoulder dislocation and may go unrecognized; this can alter the necessary bony constraint within the glenohumeral joint. To deal with HSLs, remplissage is a safe procedure with low complication rates, low recurrent instability rates, and good patient outcome scores compared with many of the other alternative techniques. On the other hand, a great number of techniques have been described to treat reverse Hill-Sachs lesions (RHSLs). In this article, we propose a method of treatment for combined simultaneous HSL and RHSL shoulder injuries. However, consensus on a specific treatment is yet to be established. We present an arthroscopic treatment guideline for patients with shoulder instability due to anterior and posterior labral lesions, HSL, and RHSL.
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Affiliation(s)
- Santiago Arauz
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - David González-Martín
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain,Universidad de La Laguna, Tenerife, Spain,Address correspondence to David González-Martín, M.D., Ph.D., Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain and Universidad de La Laguna, Tenerife, Spain.
| | - Marcelo Quiroga
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - Pedro Guillén
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
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8
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Romano AM, Edwards TB, Nastrucci G, Casillo P, Di Giunta A, Zappia M, Susanna M, Ascione F. Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications. Knee Surg Sports Traumatol Arthrosc 2021; 29:2348-2355. [PMID: 33074421 DOI: 10.1007/s00167-020-06317-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage. METHODS The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill-Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs. RESULTS Twelve male patients with a mean follow-up of 37.3 months ± 10.5 (range, 24-58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination. CONCLUSION The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alfonso M Romano
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | - Pasquale Casillo
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | | | - Francesco Ascione
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy. .,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy.
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9
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Hachem AI, Bascones KR, Costa D’O G, Rondanelli S R, Rius X. Arthroscopic Knotless Subscapularis Bridge Technique for Reverse Hill-Sachs Lesion With Posterior Shoulder Instability. Arthrosc Tech 2021; 10:e103-e116. [PMID: 33532216 PMCID: PMC7823086 DOI: 10.1016/j.eats.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
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 anchors-with one crossing the subscapularis tendon and the other embracing it-along 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.
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Affiliation(s)
- Abdul-ilah Hachem
- Shoulder Unit, Department of Orthopedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain,University of Barcelona, Barcelona, Spain,Address correspondence to Abdul-Ilah Hachem, M.D., C/ Feixa Llarga S/N Hospital de Bellvitge Pl 10, Traumatology and Orthopedic Secretary, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat), Barcelona, Spain 08907.
| | - Karla R. Bascones
- Shoulder and Elbow Unit, Department of Orthopaedic and Trauma Surgery, Hospital Asepeyo Sant Cugat, Barcelona, Spain
| | - Gino Costa D’O
- Shoulder Unit, Department of Orthopedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rafael Rondanelli S
- Shoulder Unit, Department of Orthopedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Xavi Rius
- Shoulder Unit, Department of Orthopedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
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10
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Gilat R, Haunschild ED, Tauro T, Evuarherhe A, Fu MC, Romeo A, Verma N, Cole BJ. Distal Tibial Allograft Augmentation for Posterior Shoulder Instability Associated With Glenoid Bony Deficiency: A Case Series. Arthrosc Sports Med Rehabil 2020; 2:e743-e752. [PMID: 33364612 PMCID: PMC7754527 DOI: 10.1016/j.asmr.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/08/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To report the clinical history and preliminary outcomes of patients who underwent posterior glenoid reconstruction using a distal tibial allograft (DTA) for the management of posterior shoulder instability with glenoid bone loss. Methods Patients who underwent posterior shoulder stabilization with a DTA in our institution between 2011 and 2019 were retrospectively reviewed. Demographic characteristics, operative reports, and clinical and functional outcomes were recorded. Outcomes included postoperative range of motion (ROM), recurrent instability, complications, and revision surgery. All patients underwent at least 1 year of follow-up, except 2 patients who underwent revision surgery. Preoperative and postoperative ROM was compared using the 2-tailed Student t test for paired samples. Results Ten patients who underwent DTA augmentation for posterior instability were included, comprising 2 female and 8 male patients with an average age of 24 years (range, 17-35 years). Five patients had a prior sports-related traumatic event, and 2 patients had a seizure disorder. Seven patients had undergone a prior stabilization procedure. The average reverse bony Bankart lesion was 26% of the glenoid diameter. Concomitant procedures included 4 capsular repairs, 2 labral repairs, 2 capsular plications, and 1 repair for humeral avulsion of the glenohumeral ligament. One patient reported recurrent instability after surgery. Two patients underwent revision surgery, with one removal of symptomatic hardware and one early revision owing to screw penetration into the glenoid. There was no significant difference in preoperative versus postoperative ROM. Conclusions Posterior shoulder instability with significant bony deficiency can be managed using DTA augmentation with good outcomes and a reasonable complication rate in these challenging cases. Level of Evidence Level IV, case series.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Tracy Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Aghogho Evuarherhe
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony Romeo
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
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11
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Brilakis E, Malahias MA, Patramani M, Avramidis G, Gerogiannis D, Trellopoulos A, Antonogiannakis E. All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill-Sachs Lesion Caused by Locked Posterior Shoulder Dislocation. JOINTS 2019; 7:71-77. [PMID: 34195533 PMCID: PMC8236323 DOI: 10.1055/s-0039-3401820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/04/2019] [Indexed: 10/31/2022]
Abstract
Purpose This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill-Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63-104 months). Results No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50-90 degrees; p < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80-90 degrees; p < 0.01). The active forward flexion was increased ( p < 0.01), from 60 degrees (range, 30-180 degrees) at the baseline to 180 degrees (range, 160-180 degrees) at the last follow-up and the internal rotation was gained ( p < 0.01) from the level of buttock (range, lateral thigh-T12) at the baseline to the T11 level (range, T7-L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4-22) to 35 (range, 33-35; p < 0.01) and the Oxford instability score from 5 (range, 3-16) to 46 (range, 43-48; p < 0.01), respectively. Conclusion The arthroscopic McLaughlin procedure in substantial reverse Hills-Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence This is a therapeutic study, case series with no comparison group, Level IV.
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Affiliation(s)
| | | | - Maria Patramani
- 3rd Orthopaedic Department, Hygeia General Hospital, Athens, Greece
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12
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Bernholt DL, Lacheta L, Goldenberg BT, Millett PJ. Arthroscopic Knotless Modified McLaughlin Procedure for Reverse Hill-Sachs Lesions. Arthrosc Tech 2019; 9:e65-e70. [PMID: 32021776 PMCID: PMC6993127 DOI: 10.1016/j.eats.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/02/2019] [Indexed: 02/03/2023] Open
Abstract
Posterior shoulder dislocations often are associated with an impression fracture involving the anterior humeral head known as a reverse Hill-Sachs lesion. These injuries can result in significant bone defects that require surgical management to prevent them from engaging the posterior glenoid. We present a modified arthroscopic, knotless McLaughlin procedure (tenodesis of the subscapularis tendon into the bone defect) for the treatment of small-to medium-sized, engaging Hill-Sachs lesions. The knotless fashion aims to eliminate potential problems associated with knot tying, such as knot migration, knot impingement, and chondral abrasion.
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Affiliation(s)
- David L. Bernholt
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A,The Steadman Clinic, Vail, Colorado, U.S.A
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Peter J. Millett
- The Steadman Clinic, Vail, Colorado, U.S.A,Address correspondence to Peter J. Millett, M.D., M.Sc., Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr., Suite 400, Vail, CO 81657.
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Torres TP, Lima S, Gutierre M. Modified Arthroscopic McLaughlin Procedure in the Treatment of Posterior Glenohumeral Instability-Technical Note. Rev Bras Ortop 2019; 54:228-232. [PMID: 31363274 PMCID: PMC6510577 DOI: 10.1016/j.rbo.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/17/2018] [Indexed: 11/15/2022] Open
Abstract
The diagnosis of and the treatment for traumatic posterior shoulder dislocation are challenging. Some series describe that between 60 and 80% of these lesions are not diagnosed during the first visit to the emergency room. As such, dislocations are frequently found after several days or even weeks, adding complexity to their treatment. Posterior dislocations are usually accompanied by a print fracture on the anterior surface of the humeral head, known as reverse Hill-Sachs injury. This bone defect can "engage" into the posterior glenoid ridge, leading to recurrent instability and progressive joint destruction. The authors describe a modified arthroscopic McLaughlin procedure, which allows filling the bone defect with the upper third of the subscapular tendon, avoiding recurrence of the posterior instability. Next, a posterior Bankart lesion repair is performed along with a tenodesis of the long portion of the bicipital tendon. This technique, in addition of repairing the posterior chondrolabral lesion, creates a remplissage effect, making the repair stronger and representing an optimal procedure for the definitive treatment of recurrent posterior luxation. It is an entirely arthroscopic procedure, avoiding the disadvantages of an open procedure.
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Affiliation(s)
- Tiago Pinheiro Torres
- Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
- Casa de Saúde da Boavista, Porto, Portugal
- Hospital CUF, Porto, Portugal
| | - Sara Lima
- Casa de Saúde da Boavista, Porto, Portugal
- Hospital CUF, Porto, Portugal
| | - Manuel Gutierre
- Casa de Saúde da Boavista, Porto, Portugal
- Hospital CUF, Porto, Portugal
- Centro Hospitalar de São João, Porto, Portugal
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14
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Arafa MS, Abdelbadie A. The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:999-1007. [DOI: 10.1007/s00590-019-02417-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
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15
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Byram GW, Field AC, Field LD. Arthroscopic Management of Locked Posterior Shoulder Dislocations. Arthrosc Tech 2018; 7:e945-e949. [PMID: 30258776 PMCID: PMC6153398 DOI: 10.1016/j.eats.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/25/2018] [Indexed: 02/03/2023] Open
Abstract
Locked posterior shoulder dislocations occur relatively uncommonly but pose aunique array of challenges for the treating surgeon. Posterior labral detachments and capsular damage along with reverse Hill-Sachs lesions are commonly present in these patients and must often be addressed at the time of surgical intervention. Multiple open and arthroscopic procedures that address these pathologic lesions have been described. Arthroscopic shoulder stabilization for patients with locked posterior shoulder dislocations for whom significant posterior instability and subluxation persist following closed reduction is described. A specific patient who underwent both arthroscopic posterior stabilization and supplemental advancement of the subscapularis into the reverse Hill-Sachs defect serves as a case example of this technique.
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Affiliation(s)
| | | | - Larry D. Field
- Address correspondence to Dr. Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325, Jackson, MS 39202, U.S.A.
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16
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Reverse-Hill-Sachs-Läsion bei dorsal verhakter Schulterluxation. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Kelly BJ, Field LD. Arthroscopic Transfer of the Subscapularis Tendon for Treatment of a Reverse Hill-Sachs Lesion. Arthrosc Tech 2017; 6:e2061-e2064. [PMID: 29399472 PMCID: PMC5793892 DOI: 10.1016/j.eats.2017.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
Posterior shoulder instability occurs less often than anterior shoulder instability but is increasingly recognized as a relatively common condition. The reverse Hill-Sachs lesion is present in some patients with posterior instability and is best described as an impaction fracture of the anterior humeral head. These reverse Hill-Sachs lesions can predispose the patient to recurrent instability events and may need to be addressed directly at the time of surgery. Multiple open and arthroscopic procedures have been described to transfer bone or soft tissue structures into this reverse Hill-Sachs defect. An arthroscopic technique for the transfer of the subscapularis tendon into the defect using a standard 30° arthroscope, standard portals, and suture anchors is described.
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Affiliation(s)
- Brian J. Kelly
- Address correspondence to Brian J. Kelly, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 East Fortification Street, Jackson, MS 39202, U.S.A.Mississippi Sports Medicine and Orthopaedic Center1325 East Fortification StreetJacksonMS39202U.S.A.
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18
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Alepuz ES, Pérez-Barquero JA, Jorge NJ, García FL, Baixauli VC. Treatment of The Posterior Unstable Shoulder. Open Orthop J 2017; 11:826-847. [PMID: 28979596 PMCID: PMC5611705 DOI: 10.2174/1874325001711010826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND It is estimated that approximately 5% of glenohumeral instabilities are posterior. There are a number of controversies regarding therapeutic approaches for these patients. METHODS We analyse the main surgery alternatives for the treatment of the posterior shoulder instability. We did a research of the publications related with posterior glenohumeral instability. RESULTS There are conservative and surgical treatment options. Conservative treatment has positive results in most patients, with around 65 to 80% of cases showing recurrent posterior dislocation. There are multiple surgical techniques, both open and arthroscopic, for the treatment of posterior glenohumeral instability. There are procedures that aim to repair bone defects and others that aim to repair soft tissues and capsulolabral injuries. The treatment should be planned according to each case on an individual basis according to the patient characteristics and the injury type. Surgical treatment is indicated in patients with functional limitations arising from instability and/or pain that have not improved with rehabilitation treatment. The indications for arthroscopic treatment are recurrent posterior subluxation caused by injury of the labrum or the capsulolabral complex; recurrent posterior subluxation caused by capsuloligamentous laxity or capsular redundancy; and multidirectional instability with posterior instability as a primary component. Arthroscopic assessment will help identify potential injuries associated with posterior instability such as bone lesions or defects and lesions or defects of soft tissues. The main indications for open surgery would be in cases of Hill Sachs lesions or broad reverse Bankart lesions not accessible by arthroscopy. We indicated non-anatomical techniques (McLaughlin or its modifications) for reverse Hill-Sachs lesions with impairment of the articular surface between 20% and 50%. Disimpaction of the fracture and placement of bone graft (allograft or autograft) is a suitable treatment for acute lesions that do not exceed 50% of the articular surface and with articular cartilage in good condition. Reconstruction with allograft may be useful in lesions affecting up to 50% of the humeral surface and should be considered when there is a situation of non-viable cartilage at the fracture site. For defects greater than 50% of the articular surface or in the case of dislocations over 6 months in duration where there is poor bone quality, some authors advocate substitution techniques as a treatment of choice. The main techniques for treating glenoid bone defects are posterior bone block and posterior opening osteotomy of the glenoid. CONCLUSIONS The treatment of the posterior glenohumeral instability has to be individualized based on the patient´s injuries, medical history, clinical exam and goals. The most important complications in the treatment of posterior glenohumeral instability are recurrent instability, avascular necrosis and osteoarthritis.
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Affiliation(s)
| | | | - Nadia Jover Jorge
- Department of Trauma and Orthopaedic Surgery, Unión de Mutuas. Valencia. Spain
| | - Francisco Lucas García
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Carratalá Baixauli
- Department of Trauma and Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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[Diagnostics and treatment concepts for anteroinferior shoulder instability : Current trends]. DER ORTHOPADE 2017; 46:877-892. [PMID: 28799049 DOI: 10.1007/s00132-017-3454-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Shoulder instability arises when static or dynamic stabilizers deviate from the natural equilibrium. The most common form of shoulder instability is in an anteroinferior direction, affects young athletes in contact sports and can lead to permanent impairment of shoulder function and early degeneration of the joint. Conservative as well as operative therapy options have been controversially discussed for years. This article describes the current state of diagnostics, current trends in therapy decisions and relevant therapy options for anterior shoulder instability.
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Abstract
PURPOSE Bilateral posterior fracture dislocation is a rare injury commonly associated with seizures. When the humeral head defect (reverse Hill-Sachs lesion) is between 20% and 45%, operative fixation using a modified McLaughlin procedure is recommended. This video demonstrates a case of bilateral posterior fracture dislocation after a drug-induced seizure treated with a modified McLaughlin procedure. METHODS The original McLaughlin procedure involved transfer of the subscapularis tendon from the lesser tuberosity to the reverse Hill-Sachs defect. However, the modified McLaughlin procedure is more commonly described in the literature as of late and involved the transfer of the lesser tuberosity along with the subscapularis. RESULTS This video demonstrates the modified McLaughlin technique for a posterior fracture dislocation. Computerized tomography confirms the articular impression fractures of the proximal humerus. Through a deltopectoral approach, the lesser tuberosity along with the subscapularis tendon was transferred into the defect. CONCLUSIONS The modified McLaughlin procedure demonstrates excellent clinical and radiographic results after posterior fracture dislocation of the shoulder with a reverse Hill-Sachs lesion between 25% and 45%.
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Mitchell JJ, Vap AR, Sanchez G, Liechti DJ, Chahla J, Moatshe G, Ferrari MB, Provencher MT. Concomitant Reverse Hill-Sachs Lesion and Posterior Humeral Avulsion of the Glenohumeral Ligament: Treatment With Fresh Talus Osteochondral Allograft and Arthroscopic Posterior Humeral Avulsion of the Glenohumeral Ligament and Labrum Repair. Arthrosc Tech 2017; 6:e987-e995. [PMID: 28970982 PMCID: PMC5621160 DOI: 10.1016/j.eats.2017.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/05/2017] [Indexed: 02/03/2023] Open
Abstract
Chronic posterior glenohumeral joint instability can be a challenging clinical entity for patients and surgeons alike. In the setting of a posterior dislocation, a large anterior humeral impaction injury (reverse Hill-Sachs [HS]) may occur, leading to engagement of the humerus with the posterior glenoid bone, especially during internal rotation of the joint. A reverse HS is especially debilitating because of the significant portion of affected humeral head cartilage, and is made worse in the setting of ligamentous disruption such as a posterior humeral avulsion of the glenohumeral ligament (HAGL) lesions. Although several nonanatomic procedures to address these defects have been previously described, recent interest in anatomic reconstructions capable of restoring the cartilage surface of the humeral head has led to the use of bone grafts (autografts and allografts) to restore the articular contour of the humeral head in conjunction with anatomic repair of associated soft tissue injuries. We present our preferred technique for an anatomic repair of a posterior HAGL lesion in combination with reconstruction of an engaging reverse HS lesion using an unmatched hemitalar allograft.
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Affiliation(s)
| | | | | | | | | | | | | | - Matthew T. Provencher
- Address correspondence to Matthew T. Provencher, M.D., Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.Steadman Philippon Research InstituteThe Steadman Clinic181 West Meadow DriveSuite 400VailCO81657U.S.A.
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22
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Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2017; 1:325-331. [PMID: 28461964 PMCID: PMC5367527 DOI: 10.1302/2058-5241.1.160016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness. Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term. In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle. The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications. ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues. Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time. The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
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Affiliation(s)
- Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faini
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Garro
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Agostino Tucciarone
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Posterior shoulder fracture–dislocation: an update with treatment algorithm. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:285-294. [DOI: 10.1007/s00590-016-1840-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/11/2016] [Indexed: 11/27/2022]
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Cerciello S, Visonà E, Morris BJ, Corona K. Bone block procedures in posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:604-11. [PMID: 25906911 DOI: 10.1007/s00167-015-3607-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 04/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Posterior shoulder dislocation is often associated with bone defects. Surgical treatment is often necessary to address these lesions. The aim of the present systematic review was to analyse the available literature concerning bone block procedures in the treatment of bone deficiencies following posterior dislocation. In addition, the methodology of the articles has been evaluated through the Coleman methodology score. METHODS A systematic review of the literature was performed using the keywords "posterior shoulder instability", "posterior shoulder dislocation", "bone loss", "bone defect", "bone block", and "bone graft" with no limit regarding the year of publication. All English-language articles were evaluated using the Coleman methodology score. RESULTS Fifty-four articles were identified, and 13 articles met inclusion criteria. The initial cohort included 208 shoulders, and 182 were reviewed at an average follow-up of 72.7 months (±55.2). The average Coleman score was 57.2 (±8.0). The most lacking domains were the size of study population, the type of study, and the procedure for assessing outcomes. All the articles showed an increase in the outcome scores. Radiographic evaluation revealed degenerative changes such as osteoarthritis and graft lysis in most of the series. CONCLUSIONS This review confirms the lack of studies with good methodological quality. However, bone grafting is a reliable option since significant improvement in all scores is reported. Although a low incidence of recurrence is generally described, there are concerns that the results may deteriorate over time as evidenced by graft lysis and glenohumeral osteoarthritis in up to one-third of patients. LEVEL OF EVIDENCE Systematic review, Level IV.
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Affiliation(s)
- Simone Cerciello
- Università degli Studi del Molise, Campobasso, Italy. .,, Via Riccardo Zandonai 11, 00135, Rome, Italy.
| | | | - Brent Joseph Morris
- Shoulder and Elbow Surgeon Lexington Clinic Orthopedics - Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, KT, USA
| | - Katia Corona
- Università degli Studi del Molise, Campobasso, Italy
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The split portal: Description of a new accessory posterior portal for arthroscopic shoulder instability procedures. Knee Surg Sports Traumatol Arthrosc 2016; 24:625-9. [PMID: 26685695 DOI: 10.1007/s00167-015-3911-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Open approach to the posterior shoulder during bone block for posterior shoulder instability is challenging. Anatomical study was performed to identify landmarks of a portal, avoiding soft tissue damage, between the infraspinatus (IS) and teres minor (TM) muscles and distant from the supra-scapular nerve (SSN) for arthroscopic shoulder bone block. METHODS Eight fresh-frozen cadaveric shoulder specimens were used. The arthroscope was introduced through the soft point (SP). A guide wire was placed through the SP, in the rotator interval direction. A posterior open dissection exposed the split between the IS and TM. A new guide wire was placed into the split, parallel to the first wire, to locate the new posterior arthroscopic approach. Ten distances were measured to define the safe position. RESULTS The mean values were: SP to split IS-TM: 2 ± 0.2 (2-2.8); spinal bone to split IS-TM: 5 ± 0.5 (3-6.2); split IS-TM to posterior glenoid 6 o'clock: 1.3 ± 0.3 (0.6-1.6), 9 o'clock: 1.5 ± 0.3 (1-1.9), and 12 o'clock: 2 ± 0.1 (2.1-2.4); SSN to posterior glenoid 6 o'clock: 2.4 ± 0.2 (2.1-2.6), 9 o'clock: 1.7 ± 0.1 (1.5-1.8), and 12 o'clock: 1.5 ± 0.3 (1.2-2.1); and SSN to split IS-TM: 2 ± 0.3 (1.2-2.1). CONCLUSION This preliminary anatomical study described a posterior arthroscopic portal located 2 cm under the SP, parallel to the SP portal direction, and finishing between 7 and 8 o'clock at the posterior rim of the glenoid. For arthroscopic shoulder bone block, this portal can avoid muscle and SSN lesions.
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Arthroscopic Reverse Remplissage for Posterior Instability. Arthrosc Tech 2016; 5:e43-7. [PMID: 27073776 PMCID: PMC4809750 DOI: 10.1016/j.eats.2015.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/22/2015] [Indexed: 02/03/2023] Open
Abstract
Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a "reverse Hill-Sachs lesion." The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor-based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure.
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27
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Euler SA, Spiegl UJA, Millett PJ. Posterior Shoulder Instability with a Reverse Hill-Sachs Defect: Repair with Use of Combined Arthroscopic Labral Repair and Fracture Disimpaction: A Case Report. JBJS Case Connect 2014; 4:e86. [PMID: 29252445 DOI: 10.2106/jbjs.cc.n.00015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Simon A Euler
- Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ulrich J A Spiegl
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Peter J Millett
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
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28
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[Shoulder dislocation in athletes]. Chirurg 2014; 85:864-71. [PMID: 25113089 DOI: 10.1007/s00104-014-2769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Shoulder dislocation is a common injury in athletes. Surgical and non-surgical therapy options are still the subject of controversial debate. STUDY AIM This article presents important considerations for decision-making and current concepts for the therapy of shoulder dislocation in athletes. METHODS A selective literature search was carried out in PubMed. RESULTS Surgical and non-surgical therapy options are described in the literature without yet defining a gold standard. CONCLUSION Early surgical stabilization is currently recommended in young athletes. For decision-making numerous sport and patient-related factors need to be considered. Most athletes are able to return to the pre-injury level after surgical stabilization.
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Cvetanovich GL, Bhatia S, Provencher MT, Cole BJ. Treatment of Bone Defects in Posterior Instability. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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