Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to opt
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SHOULDER
Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications Alfonso M. Romano1,2 · T. Bradley Edwards3 · Guglielmo Nastrucci1 · Pasquale Casillo1 · Angelo Di Giunta4 · Marcello Zappia5 · Massimiliano Susanna6 · Francesco Ascione1,2 Received: 4 May 2020 / Accepted: 2 October 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
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. Keywords Subscapularis remplissage · Posterior shoulder dislocation · Arthroscopic reduction · Locked shoulder · Humeral head defect · Reverse Hill–Sachs · McLaughlin lesion
Introduction * Francesco Ascione [email protected] 1
Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
2
Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123 Napoli, Italy
3
Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
4
Orthopaedic Division of Policlinico ‘G.B. Morgagni’, Catania, Italy
5
Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
6
Orthopedic and Trauma Unit, San Donà di Piave Hospital, Venezia, Italy
Posterior shoulder dislocations are usually caused by seizures, electric shock or trauma during which contraction of the internal rotators (subscapularis, latissimus dorsi, pectoralis maj
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