Posterior Shoulder Dislocation with Engaging Reverse Hill-Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization

The clinical and functional outcomes of closed reduction and arthroscopic McLaughlin procedure in patients with neglected locked posterior shoulder dislocation

INTRODUCTION

Posterior shoulder dislocation with a reverse Hill-Sachs lesion is a rare and complex injury, requiring specialized treatment due to the difficulty in diagnosis, reduction, and addressing both sides of the pathology to reduce the potential for recurrent dislocation.

PURPOSE

To evaluate the clinical and functional outcomes of closed reduction and arthroscopic McLaughlin procedure with posterior labral repair in patients with neglected locked posterior shoulder dislocation for less than 12 weeks.

METHODS

A prospective study was conducted at university hospitals, managing 15 patients with neglected locked posterior shoulder dislocation for less than 12 weeks and concomitant engaging reverse Hill-Sachs lesions of less than 40% of the humeral articular surface. They were treated with closed reduction and arthroscopic McLaughlin procedure with posterior labral repair. Patients' assessments included shoulder range of motion, pain levels using the visual analog scale (VAS) score, and functional outcome using the Oxford instability score and the University of California Los Angeles Shoulder Scale (UCLA) with at least 2 years of postoperative follow-up.

RESULTS

All 15 patients reported no recurrent dislocation and restored shoulder motion at the final follow-up. External rotation significantly improved from 0° to a mean of 65° in adduction, at 90° of abduction, the respective measurement was 85° (p < 0.01). Active forward flexion increased from 35° to 145° (p < 0.01). UCLA and Oxford instability scores Showed marked improvement (p < 0.01).

CONCLUSION

Closed reduction and arthroscopic McLaughlin procedure with posterior labral repair is a safe and effective way for managing patients with locked neglected posterior shoulder dislocations that have been neglected for less than 12 weeks with engaging reverse Hill-Sachs lesion defect, less than 40% of the humeral head.

The Posterior Dislocation of the Shoulder With Reverse Hill-Sachs Lesion and Humerus Lesser and Greater Tuberosity Fracture

Posterior shoulder dislocations are the rarest of all shoulder dislocations. They are commonly associated with seizures, electric shocks, or trauma. This case report presents a 60-year-old male with a posterior shoulder dislocation complicated by fractures of the greater tuberosity (GT) and lesser tuberosity (LT) and a reverse Hill-Sachs lesion. The patient was treated surgically using a modified McLaughlin procedure. This case highlights the importance of the early recognition and appropriate surgical management of complex posterior shoulder dislocations to prevent recurrent instability and ensure optimal functional recovery.

Low Recurrence of Instability and Satisfying Patient-Reported Outcomes Following Various Surgical Treatments of Reverse Hill-Sachs Lesions in the Setting of Posterior Instability: A Systematic Review

PURPOSE

To systematically review the literature and report the outcomes of various surgical treatments for reverse Hill-Sachs lesions (RHSL) in the setting of posterior shoulder instability.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. All studies assessing outcomes of surgical treatment of RHSL from inception to January 2023 were identified in PubMed, Embase, and Cochrane Library. Inclusion criteria consisted of studies reporting outcomes, minimum mean 1-year follow-up, and minimum Level IV evidence. Outcomes were assessed using Forest plots with random effects models using R software.

RESULTS

A total of 29 studies consisting of 291 patients were included with a mean age of 42 years (range 16-88 years), 87% male gender, and mean follow-up of 4.5 years. The mean size of impacted or affected cartilage was 35%, and time from injury to surgery was mean 15 weeks. Nearly all studies were Level IV evidence, and quality of studies was low. Random effect models were performed, and data are presented as range. A low incidence of instability was noted for all surgical techniques with good patient-reported outcome measures. Most studies reported outcomes of the modified McLaughlin procedure (13 studies, 126 patients) with overall Constant-Murley Score of 65 to 92. Trends were seen towards better Constant-Murley Score and external rotation with a shorter delay between injury, and when arthroscopic and joint preserving treatments were performed.

CONCLUSIONS

This systematic review showed low rates of instability recurrence, reproducible range of motion, and favorable patient-reported outcome measures were reported following all treatments for RHSLs with posterior instability. There was a significant association between better outcomes and a shorter delay between injury and surgery. The level of evidence is limited, given the small and retrospective studies which can be explained by the rarity of these injuries. LEVEL OF EVIDENCE: Level IV; systematic review of Level III and IV studies.

McLaughlin technique and humeral grafting provide similar results for treatment of reverse Hill-Sachs lesions: A systematic review

Purpose

Various surgical treatments have been described for the treatment of reverse Hill-Sachs lesions (rHSls) sized between 20% and 50% in the case of posterior shoulder dislocation. The aim of this systematic review is to report the clinical and radiological outcomes of subscapularis or lesser tuberosity transfer (McLaughlin and modified procedures) compared to bone or osteochondral autograft or allograft.

Methods

A systematic review was performed on five medical databases up to December 2022. The inclusion criteria were clinical studies of all levels of evidence describing clinical or radiological outcomes of either procedure. The assessment of the quality of evidence was performed with the Modified Coleman Score.

Results

A total of 14 studies (five prospective and nine retrospective) were included. A total of 153 patients (155 shoulders, 78.4% male) with a mean age of 37.2 (22-79) years were reviewed at an average follow-up of 53.1 (7.1-294) months. No relevant difference was found for the clinical scores, range of motion, complications and redislocation rate between the two treatments. Radiological osteoarthritis (OA) was reported in 11% (10/87) in the McLaughlin group and in 21% (16/73) in the humeral reconstruction group.

Conclusions

McLaughlin and anatomic humeral reconstruction lead to similar satisfactory clinical results and a low redislocation rate in the treatment of rHSls. Anatomic humeral reconstruction seems associated with an increased risk of OA progression.

Level of Evidence

Level IV.

Clinical, Diagnostic, and Therapeutic Characteristics of Posterior Glenohumeral Instability

Posterior shoulder instability (PSI) is a shoulder pathology that is challenging to diagnose, leading to treatment delay and exacerbation of symptoms. Etiology can be both traumatic and atraumatic, and a comprehensive clinical history plays a significant role in achieving diagnosis. Imaging in the setting of PSI can reveal a reverse-Bankart lesion, a reverse Hill-Sachs lesion, posterior labral cysts, and potentially glenoid or lesser tuberosity fractures. Both conservative and surgical options exist for patients with PSI, and management often depends on case severity, extent of bone loss, and patient goals and expectations. Holistic patient education regarding the etiologies, mechanisms and possible treatment options available is pivotal for achieving high levels of patient satisfaction and optimal outcomes.

Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series

BACKGROUND

Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified).

METHODS

This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables.

RESULTS

Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant -Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis.

CONCLUSIONS

In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.

Posterior shoulder dislocation with associated reverse Hill-Sachs lesion: clinical outcome 10 years after joint-preserving surgery

INTRODUCTION

Posterior shoulder dislocation in association with reverse Hill-Sachs lesion is a rather rare injury. Few studies reporting results after joint-preserving surgery in these cases are available. This current study presents the clinical outcomes 10 years postoperatively.

MATERIALS AND METHODS

In a prospective case series, we operatively treated 12 consecutive patients (all males) after posterior shoulder dislocation with associated reverse Hill-Sachs lesion using joint-preserving techniques. Patients received surgery in a single center between January 2008 and December 2011. The joint-preserving surgical procedure was chosen depending on the defect size and bone quality. The following outcome-measures were analyzed: Constant-Score, DASH-Score, ROWE-Score, and SF-12. Results 1, 5, and 10 years postoperatively were compared.

RESULTS

Out of 12 patients, ten patients (83.3%) were followed-up with a mean follow-up interval of 10.7 years (range 9.3-12.8). The mean patient age at the time of the last follow-up was 51 years (32-66). The outcome scores at the final follow-up were: Constant 92.5 (range 70.0-100), DASH 3.2 (0.0-10.8), ROWE 91.0 (85.0-100), and SF-12 87.8 (77.5-98.3). Clinical results had improved from 1 to 5 years postoperatively and showed a tendency for even further improvement after 10 years.

CONCLUSIONS

Joint-preserving surgical therapy of posterior shoulder dislocation provides excellent results when the morphology of the reverse Hill-Sachs lesion is respected in surgical decision-making.

TRIAL REGISTRATION

223/2012BO2, 02 August 2010.