Arthroscopic Knotless Modified McLaughlin Procedure for Reverse Hill-Sachs Lesions

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Arthroscopy

Background:

• Posterior shoulder dislocations frequently involve reverse Hill-Sachs lesions, characterized by anterior humeral head impression fractures.
• These bone defects can lead to glenoid engagement, necessitating surgical intervention.
• Engaging reverse Hill-Sachs lesions pose a risk for recurrent instability and further glenoid damage.

Purpose of the Study:

• To present a modified arthroscopic, knotless McLaughlin procedure for treating small-to medium-sized, engaging reverse Hill-Sachs lesions.
• To evaluate the feasibility and technique of a knotless subscapularis tenodesis for addressing humeral head bone defects.
• To offer an alternative surgical approach that mitigates complications associated with traditional knot tying in arthroscopic procedures.

Main Methods:

• A modified arthroscopic technique involving a knotless McLaughlin procedure was employed.
• The subscapularis tendon was tenodesed into the anterior humeral head bone defect.
• The procedure focused on treating small-to medium-sized engaging reverse Hill-Sachs lesions.

Main Results:

• The knotless approach was successfully implemented for treating engaging reverse Hill-Sachs lesions.
• This technique aims to prevent complications such as knot migration, impingement, and chondral abrasion.
• The modified procedure provides a viable surgical option for specific types of posterior shoulder instability.

Conclusions:

• The arthroscopic knotless McLaughlin procedure is a promising technique for managing engaging reverse Hill-Sachs lesions.
• Eliminating the need for knot tying potentially improves patient outcomes and reduces intraoperative risks.
• This modified approach offers a valuable addition to the surgical armamentarium for posterior shoulder instability.