Posterior Shoulder Instability Treated with Arthroscopic Bankart and McLaughlin Techniques
Abstract
Introduction: Traumatic posterior shoulder dislocations are uncommon and often produce anterior humeral head defects (reverse Hill–Sachs lesions) and posterior labral injuries (reverse Bankart lesions) due to abrupt posterior translation of the humeral head. These injuries frequently involve engagement between the humeral head and the glenoid. Although nonoperative management is often favorable, recurrent dislocation episodes may persist in 65–80% of patients who do not undergo surgery. Both open and ar- throscopic surgical procedures have been described for persistent dislocations. Objective: To describe an arthroscopic technique adapted from the open McLaughlin procedure, compare it with approaches reported in the literature, and present outcomes from three consecutive cases. Materials and Methods: Three patients (ages 26, 30, and 45) were operated on by the same surgeon. Mean follow-up was 7 months. Outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Western Ontario Shoulder Instability Index (WOSI). Results: Shoulder stability was documented at approximately 3 months. No redislocations, subjective instability, or infections were reported during follow-up. Conclusion: The arthroscopic technique achieved joint stability with full range of motion while avoiding extensive open approaches and their associated complications. This arthroscopic variantrepresents a minimally invasive alternative for managing posterior shoulder instability.Downloads
References
Longo UG, Rizzello G, Locher J, Salvatore G, Florio P, Maffulli N, et al. Bone loss in patients with posterior glenohumeral instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016;24(2):612-7. https://doi.org/10.1007/s00167-014-3161-8
Bühler M, Gerber C. Shoulder instability related to epileptic seizures. J Shoulder Elbow Surg 2002;11(4):339-44. https://doi.org/10.1067/mse.2002.124524
Robinson CM, Seah M, Akhtar MA. The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. J Bone Joint Surg Am 2011;93(17):1605-13.
https://doi.org/10.2106/JBJS.J.00973
Cicak N. Posterior dislocation of the shoulder. J Bone Joint Surg Br 2004;86(3):324-32.
https://doi.org/10.1302/0301-620x.86b3.14985
Besnard M, Audebert S, Godenèche A. Arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an engaging reverse Hill-Sachs lesion. Arthrosc Tech 2019;8(12):e1491-e1494. https://doi.org/10.1016/j.eats.2019.07.025
Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, et al. Acute traumatic posterior shoulder dislocation: MR findings. Radiology 2008;248(1):185-93. https://doi.org/10.1148/radiol.2481071003
Aydin N, Enes Kayaalp M, Asansu M, Karaismailoglu B. Treatment options for locked posterior shoulder dislocations and clinical outcomes. EFORT Open Rev 2019;4(5):194-200. https://doi.org/10.1302/2058-5241.4.180043
Caloia M, Rivarola H, Lois M, Galli M. Luxación posterior de hombro: inusual presentación de Bankart reverso asociada a fractura osteocondral anterior de la cabeza humeral. Artroscopia 2013;20(2):71-6. Disponible en: https://revistarelart.com/ediciones-anteriores/images/artroscopia/volumen-20-nro-2/20_02_07_caloia.pdf
Smith T, Goede F, Struck M, Wellmann M. Arthroscopic posterior shoulder stabilization with an iliac bone graft and capsular repair: a novel technique. Arthrosc Tech 2012;1(2):e181-5. https://doi.org/10.1016/j.eats.2012.07.003
Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med 2013;41(9):2005-14. https://doi.org/10.1177/0363546513493599.
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(8):e1473-e1478. https://doi.org/10.1016/j.eats.2022.03.038
Frank RM, Romeo AA, Provencher MT. Posterior glenohumeral instability: Evidence-based treatment. J Am Acad Orthop Surg 2017;25(9):610-23. https://doi.org/10.5435/JAAOS-D-15-00631
Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al. The Hill-Sachs
lesion: diagnosis, classification, and management. J Am Acad Orthop Surg 2012;20(4):242-52.
https://doi.org/10.5435/JAAOS-20-04-242
Krackhardt T, Schewe B, Albrecht D, Weise K. Arthroscopic fixation of the subscapularis tendon
in the reverse Hill- Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder. Arthroscopy 2006;22(2):227.e1-227. e6. https://doi.org/10.1016/j.arthro.2005.10.004
Martetschläger F, Padalecki JR, Millett PJ. Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion. Knee Surg Sports Traumatol Arthrosc 2013;21(7):1642-6. https://doi.org/10.1007/s00167-012-2237-6
Arcuri F, Abalo E, Barclay F. Uso de escores para evaluación de la inestabilidad de hombro.
Artroscopia 2012;19(1):67-72. Disponible en: https://revistarelart.com/ediciones-anteriores/images/artroscopia/volumen-19-nro-1/uso_de_escores_para_evaluacion.pdf
Kelly BJ, Field LD. Arthroscopic transfer of the subscapularis tendon for treatment of a reverse Hill-Sachs lesion. Arthrosc Tech 2017;6(5):e2061-e2064. https://doi.org/10.1016/j.eats.2017.06.041
Duey RE, Burkhart SS. Arthroscopic treatment of a reverse Hill-Sachs lesion. Arthrosc Tech 2013;2(2):e155-9. https://doi.org/10.1016/j.eats.2013.01.007
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
