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

Abstract

Traumatic posterior shoulder dislocations are often accompanied by an impression fracture on the anterior surface of the humeral head known as a "reverse Hill-Sachs lesion". This bony defect can engage on the posterior glenoid rim and subsequently lead to recurrent instability and progressive joint destruction. We describe a new modified arthroscopic McLaughlin procedure, which allows for filling of the bony defect with the subscapularis tendon and subsequently prevents recurrence of posterior instability. This technique creates a double-mattress suture providing a large footprint for the subscapularis and a broader surface area to allow for effective tendon to bone healing. Furthermore, it obviates the need for detaching the subscapularis tendon and avoids the morbidity potentially associated with open procedures. Level of evidence V.