Can Subscapularis Augmentation Serve as an Alternative to the Remplissage Procedure? A Case Report

Abstract

When performing surgical treatment for shoulder dislocation, the Remplissage procedure for large Hill-Sachs lesions, which correspond to off-track lesions, has been reported to yield satisfactory results using an arthroscopic approach. However, in cases of high-energy acute dislocation or acute-on-chronic dislocation, when the humeral head bony defect is too large, severe external rotation limitation may occur postoperatively, and if the bone quality is poor, there is a higher risk of anchor pull-out, leading to potential failure. To overcome these limitations, we opted to apply subscapularis augmentation instead, aiming to achieve satisfactory results. A 21-year-old male patient underwent subscapularis augmentation for a right shoulder dislocation accompanied by severe glenoid bone loss following seizures. Two years and three months later, he experienced another seizure episode without recurrence of right shoulder dislocation and showed satisfactory clinical outcomes. However, he developed a left shoulder dislocation. Therefore, we report a case of subscapularis augmentation as an alternative treatment for shoulder dislocation with significant glenoid bone loss. We aim to present a satisfactory outcome along with a literature review on this approach.

Keywords

• shoulder
• dislocation
• Hill-Sachs lesion
• epilepsy
• seizure