Skip to main content
SpringerLink
Log in

Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage.

Methods

The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill–Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs.

Results

Twelve male patients with a mean follow-up of 37.3 months ± 10.5 (range, 24–58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination.

Conclusion

The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Altan E, Senaran H, Acar MA, Aydin K, Ozbaydar MU (2013) Mozaicplasty technique for treatment of reverse Hill-Sachs lesion. Tech Shoulder Elbow Surg 14:1–4. https://doi.org/10.1007/s00264-013-2275-9

    Article  Google Scholar 

  2. Basal O, Dincer R, Turk B (2018) Locked posterior dislocation of the shoulder: A systematic review. EFORT Open Rev. 15;3(1):15–23. https://doi.org/10.1302/2058-5241.3.160089.

  3. Bock P, Kluger R, Hintermann B (2007) Anatomical reconstruction for reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients. Arch Orthop Trauma Surg 127(7):543–548. https://doi.org/10.1007/s00402-007-0359-y

    Article  PubMed  Google Scholar 

  4. Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M (2012) Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg Am 94:618–626. https://doi.org/10.2106/JBJS.K.00101

    Article  PubMed  Google Scholar 

  5. Castagna A, Delle Rose G, Borroni M, Markopoulos N, Conti M, Maradei L, Garofalo R (2009) Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder. Chir Organi Mov 93(S1):S1–S5. https://doi.org/10.1007/s12306-009-0001-y

    Article  PubMed  Google Scholar 

  6. Charalambous CP, Gullett TK, Ravenscroft MJ (2009) Modification of McLaughlin procedure for persistent shoulder instability: technical note. Arch Orthop Trauma Surg 129:753–755. https://doi.org/10.1007/s00402-008-0721-8

    Article  CAS  PubMed  Google Scholar 

  7. Cicak N (2004) Posterior dislocation of the shoulder. J Bone Joint Surg Br 86(3):324–332. https://doi.org/10.1302/0301-620X.86B3

    Article  CAS  PubMed  Google Scholar 

  8. Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164. https://doi.org/10.1097/00003086-198701000-00023

    Article  Google Scholar 

  9. Delcogliano A, Caporaso A, Chiossi S, Delcogliano M (2005) Surgical management of chronic, unreduced posterior dislocation of the shoulder. Knee Surg Sports Traumatol Arthrosc 13:151–155. https://doi.org/10.1007/s00167-004-0524-6

    Article  CAS  PubMed  Google Scholar 

  10. Diklic ID, Ganic ZD, Blagojevic ZD, Nho SJ, Romeo AA (2010) (2010) Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. J Bone Joint Surg Br 92:71–76. https://doi.org/10.1302/0301-620X.92B1.22142

    Article  CAS  PubMed  Google Scholar 

  11. Domos P, Ascione F, Wallace AL (2017) Arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in professional collision athletes. J Shoulder Elbow 11:17–25

    Article  Google Scholar 

  12. Duey RE, Burkhart SS (2013) Arthroscopic treatment of a reverse Hill-Sachs lesion. Arthrosc Tech 2:e155–e159. https://doi.org/10.1016/j.eats.2013.01.007

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605. https://doi.org/10.1016/s1058-2746(99)90097-6

    Article  CAS  PubMed  Google Scholar 

  14. Gerber C, Lambert SM (1996) Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Joint Surg Am 78:376–382. https://doi.org/10.2106/00004623-199603000-00008

    Article  CAS  PubMed  Google Scholar 

  15. Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16(6):717–721. https://doi.org/10.1016/j.jse.2007.02.123

    Article  PubMed  Google Scholar 

  16. Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX (1987) Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 69:9–18

    Article  CAS  Google Scholar 

  17. Jacquot F, Costil V, Werther JR, Atchabahian A, Sautet A, Feron JM, Doursounian L (2013) Balloon treatment of posterior shoulder dislocation with reverse Hill-Sachs injury: description of a new technique. Int Orthop 37:1291–1295. https://doi.org/10.1007/s00264-013-1877-6

    Article  PubMed  PubMed Central  Google Scholar 

  18. Keppler P, Holz U, Thielemann FW, Meinig R (1994) Locked posterior dislocation of the shoulder: treatment using rotational osteotomy of the humerus. J Orthop Trauma 8:286–292. https://doi.org/10.1097/00005131-199408000-00003

    Article  CAS  PubMed  Google Scholar 

  19. Kirkley A, Griffin S, McLintock H, Ng L (1998) The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability: The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 26:764–772. https://doi.org/10.1177/03635465980260060501

    Article  CAS  PubMed  Google Scholar 

  20. Kokkalis ZT, Mavrogenis AF, Ballas EG, Papanastasou J, Papajelopoulos PJ (2013) Modified McLaughlin technique for neglected locked posterior dislocation of the shoulder. Orthopedics 36(7):912–916. https://doi.org/10.3928/01477447-20130624-22

    Article  Google Scholar 

  21. Krackhardt T, Schewe B, Albrecht D, Weise K (2006) Arthroscopic fixation of the subscapularis tendon in the reverse Hill-Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder. Arthroscopy 22:227.e1-227.e6. https://doi.org/10.1016/j.arthro.2005.10.004

    Article  Google Scholar 

  22. Lavender CD, Hanzlik SR, Pearson SE, Caldwell PE 3rd. (2016) Arthroscopic Reverse Remplissage for Posterior Instability. Arthrosc Tech. 18;5(1):43–7. https://doi.org/10.1016/j.eats.2015.09.005

  23. Martetschläger F, Padalecki JR, Millett PJ (2013) Modified arthroscopic McLaughlin procedure for treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion. Knee Surg Sports Traumatol Arthrosc 21:1642–1646. https://doi.org/10.1007/s00167-012-2237-6

    Article  PubMed  Google Scholar 

  24. McLaughlin HL (1952) Posterior dislocation of the shoulder. J Bone Joint Surg Am 24:584–590

    Article  Google Scholar 

  25. Meyer M, Graveleau N, Hardy P, Landreau P (2007) Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy 23(5):529–536. https://doi.org/10.1016/j.arthro.2006.12.022

    Article  PubMed  Google Scholar 

  26. Park MJ, Garcia G, Malhotra A, Major N, Tjoumakaris FP, Kelly JD 4th. (2012) The evaluation of arthroscopic remplissage by highresolution magnetic resonance imaging. Am J Sports Med. 40:2331–6. https://doi.org/10.1177/0363546512456974

  27. Petersen SA (2000) Posterior shoulder instability. Orthop Clin North Am 32:263–274. https://doi.org/10.1016/s0030-5898(05)70146-2

    Article  Google Scholar 

  28. Rhee YG, Cho NS, Yoo JH, Lee WG (2015) Filling Index Score of Remplissage (FISOR): a useful measurement tool to evaluate structural outcome after remplissage. J Shoulder Elbow Surg 24(4):613–620. https://doi.org/10.1016/j.jse.2014.08.024

    Article  PubMed  Google Scholar 

  29. Robinson CM, Seah M, Akhtar MA (2011) The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. J Bone Joint Surg Am 93:1605–1613. https://doi.org/10.2106/JBJS.J.00973

    Article  PubMed  Google Scholar 

  30. Romano AM, Oliva F, Nastrucci G, Casillo P, Di Giunta A, Susanna M, Ascione F (2017) Reverse shoulder arthroplasty patient personalized rehabilitation protocol: preliminary results according to prognostic groups. Muscles Ligaments Tendons J 7:263–270. https://doi.org/10.11138/mltj/2017.7.2.263

    Article  PubMed  PubMed Central  Google Scholar 

  31. Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460

    Article  CAS  Google Scholar 

  32. Shams A, El-Sayed M, Gamal O, ElSawy M, Azzam W (2016) Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation. Eur J Orthop Surg Traumatol 26:843–849. https://doi.org/10.1007/s00590-016-1825-4

    Article  PubMed  Google Scholar 

Download references

Funding

No funds were received for this article.

Author information

Authors and Affiliations

  1. Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy

    Alfonso M. Romano, Guglielmo Nastrucci, Pasquale Casillo & Francesco Ascione

  2. Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy

    Alfonso M. Romano & Francesco Ascione

  3. Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA

    T. Bradley Edwards

  4. Orthopaedic Division of Policlinico ‘G.B. Morgagni’, Catania, Italy

    Angelo Di Giunta

  5. Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy

    Marcello Zappia

  6. Orthopedic and Trauma Unit, San Donà di Piave Hospital, Venezia, Italy

    Massimiliano Susanna

Authors
  1. Alfonso M. Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Bradley Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guglielmo Nastrucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pasquale Casillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angelo Di Giunta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcello Zappia
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimiliano Susanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francesco Ascione
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Ascione.

Ethics declarations

Conflict of interests

The authors, A.M.R., T.B.E., G.N., P.C., A.D.G., M.Z., M.S., and F.A., declare that they have not conflicts of interest.

Ethical approval

The study was approved by Institutional Review Board of ethical committee of Campolongo Hospital (ID 2019–06). This project does not infringe the Italian ethical rules and the privacy of the patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Romano, A.M., Edwards, T.B., Nastrucci, G. et al. Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications. Knee Surg Sports Traumatol Arthrosc 29, 2348–2355 (2021). https://doi.org/10.1007/s00167-020-06317-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06317-6

Keywords

Search

Navigation