Posterior Shoulder Instability: The Augmented McLaughlin Procedure

Document Type : TECHNICAL NOTE

Authors

1 Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK

2 The Reading Shoulder Unit, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK

3 Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK - Fortius Clinic, London, UK

Abstract

Posterior shoulder dislocation, whilst uncommon, is frequently missed and often associated with a significant defect on
the antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). Several techniques for stabilisation have
been described, depending on the size of the lesion. We describe an additional technique for stabilising the shoulder
following posterior dislocation by augmenting the reverse Hill-Sachs lesion with layers of extracellular matrix, thus
further filling the defect.
Level of evidence: V

Keywords


1. Cooper A. A Treatise on Dislocations and Fractures of
the Joints, Philadelphia: Lea & Blanchard; 1822.
2. Jacobs RC, Meredyth NA, Mitchelson JD. Easily Missed?
Posterior shoulder dislocations. BMJ, 2015: 31-32.
3. Cicak N. Posterior dislocation of the shoulder. The
Journal of Bone and Joint Surgery. British volume.
2004; 86(3):324-32.
4. Clyde CT, Throckmorton TW, Duquin TR. Subscapularis
Peel in Anatomic Total Shoulder Arthroplasty. Journal
of Shoulder and Elbow Arthroplasty. 2018; 2(1): 1-6.
5. Basal O, Dincer R, Turk B. Locked posterior dislocation
of the shoulder: A systematic review. EFORT Open
Reviews. 2018; 3(1):15-23.
6. Aydin N, Enes Kayaalp M, Asansu M, Karaismailoglu
B. Treatment options for locked posterior shoulder
dislocations and clinical outcomes. EFORT open
reviews. 2019; 4(5):194-200.
7. Hughes M, Neer CS. Glenohumeral joint replacement
and postoperative rehabilitation. Physical therapy.
1975; 55(8):850-8.
8. Diklic ID, Ganic ZD, Blagojevic ZD, Nho SJ, Romeo AA.
Treatment of locked chronic posterior dislocation of
the shoulder by reconstruction of the defect in the
humeral head with an allograft. The Journal of bone
and joint surgery. British volume. 2010; 92(1):71-6
9. Keppler P, Holz U, Thielemann FW, Meinig R. Locked 
posterior dislocation of the shoulder: treatment
using rotational osteotomy of the humerus. Journal of
orthopaedic trauma. 1994; 8(4):286-92.
10. Dimock R, Narvani AA. Letter to the Editor regarding
Maillot et al:“Surgical repair of large-to-massive
rotator cuff tears seems to be a better option than
patch augmentation or débridement and biceps
tenotomy: a prospective comparative study”. Journal
of shoulder and elbow surgery. 2019; 28(9):e321-2.
11. Narvani AA, Imam MA, Polyzois I, Sarkhel T, Gupta
R, Levy O, et al. The “Pull-Over” technique for all
arthroscopic rotator cuff repair with extracellular
matrix augmentation. Arthroscopy techniques. 2017;
6(3):e679-87.
12. Dimock RA, Malik S, Consigliere P, Imam MA, Narvani
AA. Superior capsule reconstruction: What do we
know? Archives of Bone and Joint Surgery. 2019;
7(1):3.
13. Hoganson DM, O’Doherty EM, Owens GE, Harilal
DO, Goldman SM, Bowley CM, et al. The retention of
extracellular matrix proteins and angiogenic and
mitogenic cytokines in a decellularized porcine
dermis. Biomaterials. 2010; 31(26):6730-7.
14. Nagra NS, Zargar N, Smith RD, Carr AJ. Mechanical
properties of all-suture anchors for rotator cuff repair.
Bone & Joint Research. 2017; 6(2):82-9.