Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: A retrospective clinical study of 13 cases

Abstract

Objective: This study aimed to present middle-term functional and radiological outcomes of the transfer of the lesser tuberosity in the management of reverse Hill-Sachs lesions following posterior dislocations of the shoulder.

Patients and methods: With a diagnosis of neglected posterior shoulder dislocation (8 locked, 5 recurrent), 13 male patients (age range: 28-72; mean age: 39.3 years) who underwent the transfer of the lesser tuberosity due to reverse Hill-Sachs lesions, were retrospectively reviewed based on functional and radiological data. The etiologies were: epilepsy in 9 patients, a traffic accident in 2 patients, and fall in 2 patients. To assess the patients' functional level, American Shoulder and Elbow Surgeons (ASES) and Constant Scores were used, and the patients' range of motion at the last follow-up was measured. To evaluate the development of arthrosis, the final follow-up control plain radiographs were examined. The average size of the defects calculated from the axial computed tomography sets was 27% (range: 20%-40%).

Results: The average length of follow-up was 30 months (range: 12-67 months). At the last follow-up visit, the main ASES and Constant Scores were 78 and 85, respectively, and the average degrees of flexion, abduction, and external rotation were 163°, 151°, and 70° respectively. The concentric reduction was observed postoperatively.

Conclusion: McLaughlin procedure appears to be a safe and effective method in the treatment of neglected posterior shoulder dislocations with reverse Hill-Sachs lesion.

Level of evidence: Level IV, Therapeutic study.

Keywords: McLaughlin procedure; Posterior shoulder dislocation; Reverse Hill-Sachs lesion; Transfer of the lesser tuberosity.

Fig. 1

Preoperative anteroposterior radiograph of right shoulder of patient number twelve.

Fig. 2

(A) Computed tomography scan of right shoulder of patient number twelve demonstrating remarkable reverse Hill-Sachs lesion in axial plane. (B) Three-dimensional computed tomography reconstruction of right shoulder of patient number eight displaying locked posterior shoulder dislocation.

Fig. 3

According to Moroder et al, to estimate the maximum relative depth of the defect in the axial CT image, line is drawn from the center of the best-fit circle to the base of the defect (d). Then, distance d is removed from the radius of the circle (r), and the result is divided through the diameter of the circle (2r).

Fig. 4

Intraoperative imagine showing fixation of the osteotomized lesser tuberculum with 2 cannulated screws.

Fig. 5

(A) Postoperative anteroposterior radiograph of patient number seven displaying concentric reduction. (B) Postoperative axial view of CT scan illustrating replacement of the lesser tuberosity into the defect area.