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. 2020 Nov;8(6):729-733.
doi: 10.22038/abjs.2020.44481.2224.

Posterior Shoulder Instability: The Augmented McLaughlin Procedure

Richard Dimock  1 , Kashif Memon  1 , Paolo Consigliere  2 , Ioannis Polyzois  1 , Mohamed A Imam  1 , A Ali Narvani  1   3
Affiliations

Posterior Shoulder Instability: The Augmented McLaughlin Procedure

Richard Dimock et al. Arch Bone Jt Surg. 2020 Nov.

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.

Keywords: McLaughlin procedure; Posterior dislocation; everse hill-sachs; ll suture anchor; xtracellular matrix.

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Figures

Figure 1
Figure 1
Axial view: The subscapularis is peeled from the lesser tuberosity. The long head of biceps (LHB) can be used to orientate the surgeon. Internal rotation may be needed to disengage the humeral head from the acromion
Figure 2
Figure 2
Axial view: Two Iconix, Stryker 2.3mm Double-stranded all suture Anchors are placed in the deepest part of the Hill-Sachs lesion, one superior, one inferior, 1.5-2cm apart. Note figure shows cross section through one anchor
Figure 3
Figure 3
The anchors are placed in the deepest part of the defect. Note stay sutures have been placed in the retracted subscapularis tendon
Figure 4
Figure 4
Axial and Anterior View: Each strand of each anchor is passed through the subscapularis tendon and the tendon is snugged down into the defect
Figure 5
Figure 5
Subscapularis is snugged into the defect. Note that the stay sutures in subscapularis have been tied into the rotator cuff laterally
Figure 6
Figure 6
Two patches of ECM (2x1cm) are prepared
Figure 7
Figure 7
Two small holes are made 1.5cm apart in each ECM. Strands from the superior anchor are passed through holes A. Strands from the inferior anchor are passed through holes B
Figure 8
Figure 8
The patches are positioned over defect, superficial to subscapularis
Figure 9
Figure 9
The patches are snugged down into the defect and the strands of the suture anchors are tied over the top of the patches. The suture ends are then shortened
Figure 10
Figure 10
The anchor sutures are tied over the ECM, further filling the defect
See this image and copyright information in PMC

References

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