Neglected anterior shoulder dislocation: open remplissage of the Hill-Sachs lesion with the infraspinatus tendon

Abstract

Neglected anterior shoulder dislocation is a rare condition; reduction usually requires an open procedure. There is usually a concurrent Hill-Sachs lesion, with the humeral head impaled over the anterior rim of the glenoid. Large, engaging Hill-Sachs lesions can contribute to continued shoulder instability, and therefore require a specific action. Reconstruction of the humeral head with an osteochondral allograft has been advocated, but allografts are not easily available in some countries, such as Egypt. For this reason, I switched to the open infraspinatus remplissage technique. I report the results with this technique, in four young adult patients who presented with a locked anterior shoulder dislocation, which had been left unreduced for 10 to 20 weeks. The infraspinatus tendon was pulled into the humeral defect with a four limbs suture anchor; as a result, the lesion became extra-articular. A Putti-Platt procedure was added to obtain anterior stability, except in one patient with a concurrent glenoid defect which required a Latarjet procedure. The mean follow-up period was 32 months, without recurrence or other complications. The mean postoperative Constant score was 74, and the range of motion was satisfactory, with a functional range of external rotation.