Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion

Authors:

Frank Martetschläger, Jeffrey R Padalecki, Peter J Millett

Abstract:

Traumatic posterior shoulder dislocations can lead to impression fractures on the anterior surface of the humeral head. Depending on the size, this so-called reverse Hill-Sachs lesion can engage on the posterior rim of the glenoid during internal rotation of the arm, leading to mechanical symptoms, pain or re-dislocation of the shoulder. Surgical intervention is indicated for cases of recurrent posterior dislocation due to an engaging reverse Hill-Sachs lesion to not only stabilize the shoulder but also help avoid progressive joint destruction and early osteoarthritis. It has been shown that a posterior capsulolabral repair (i.e. posterior Bankart repair) does not effectively treat instability in cases with engaging reverse Hill-Sachs lesions. There have been several different techniques described that address the bony pathology found in this types of cases. Current techniques for addressing the anterior humeral head defect can be subdivided into two groups—anatomical and non-anatomical reconstructions. The goal of the anatomical procedures is to restore the original shape of the humeral head with a variety of different bone grafting techniques. By distinction, the goal of the non-anatomical techniques is to restore stability by filling the defect with the subscapularis tendon.

In 1952, McLaughlin was the first to describe the subscapularis tenodesis using an open transposition of the subscapularis into the bony defect. Hawkins and Neer modified the technique and recommended transferring the subscapularis and lesser tuberosity into the defect. Since then, several reports have described a number of variations in the technique, all showing reliable clinical results. The purpose of this article is to describe an arthroscopic approach, the so-called ‘‘reverse remplissage’’ or ‘‘arthroscopic McLaughlin procedure’’ that can be used to tenodese the subscapularis tendon into the Hill-Sachs lesion. This all- arthroscopic procedure that avoids the morbidity of some of the open technique that predated it, allows one to address the posterior capsulolabral pathology and obviates the need to detach the subscapularis tendon or lesser tuberosity. This new technique uses a double-mattress suture, therefore providing a broader footprint with less tendon strangulation and has not been described for reverse remplissage yet.

For the complete study: Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion

Authors:

Abstract:

About the Author: Peter Millett, MD