Arthroscopic McLaughlin Procedure for Treatment of Posterior Instability of the Shoulder With an Engaging Reverse Hill-Sachs Lesion

Abstract

Posterior shoulder dislocation is associated with an engaging reverse Hill-Sachs lesion (i.e., involving >25% of the articular surface of the humeral head) in 28% of cases, leading to posterior instability. Isolated capsulolabral fixation usually performed to treat posterior instability is not effective at stabilizing the shoulder when there is such a bony lesion. The original McLaughlin procedure, first described in 1952, consists of detaching the subscapularis tendon from the lesser tuberosity and transferring it to the bony defect by an open approach. Several open and arthroscopic modifications of this technique have been described since this description. This article describes a truly arthroscopic McLaughlin procedure. Arthroscopy allows complete visualization of the glenohumeral joint and allows associated posterior and anterior soft-tissue lesions to be addressed at the same time. Moreover, the morbidity of open procedures is avoided. Although this procedure is known to be effective at stabilizing the shoulder, further long-term studies are required to assess the functional outcomes.