Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation

Area of Science:

• Orthopedic surgery
• Shoulder biomechanics

Background:

• Posterior shoulder dislocation is an uncommon injury (2-4%) often associated with reverse Hill-Sachs lesions.
• Previous treatments include tendon transfer, osteotomy, grafts, or arthroplasty for severe defects.

Purpose of the Study:

• To evaluate the effectiveness of subscapularis tendon transfer for reconstructing reverse Hill-Sachs defects in chronic posterior shoulder dislocations.

Main Methods:

• Eleven patients with chronic locked posterior shoulder dislocation and reverse Hill-Sachs defects (25-50% humeral head size) underwent surgery.
• The procedure involved open reduction and transfer of the subscapularis tendon with the lesser tuberosity, fixed with sutures.

Main Results:

• Significant improvement in patient-reported scores (median 30 vs. 24, P=0.002) after a mean follow-up of 29 months.
• 90% of patients experienced no pain or activity restriction; no instability was reported.
• Modified UCLA ratings showed 4 excellent, 5 good, 1 fair, and 1 poor outcome.

Conclusions:

• Subscapularis tendon transfer effectively reconstructs reverse Hill-Sachs defects, restoring stability and function in chronic posterior shoulder dislocations.
• The technique is simple, cost-effective, and avoids the need for hardware removal.