McLaughlin Procedure | Hill-Sachs Lesion | Arthroscopic Shoulder Surgery

https://drmillett.com An arthroscopic knotless modified McLaughlin procedure for a reverse Hill Sachs lesion is demonstrated in this video. To begin, a standard posterior lateral portal is established in addition to an anterior superior portal in the rotator interval and an anterior inferior portal of just superior to the subscapularis tendon. A complete diagnostic arthroscopy is performed with careful examination of the posterior capsule labral complex and the anterior humeral head which are better evaluated with the arthroscope switched to the anterior portal. Internal rotation of the humeral head can demonstrate whether the Hill Sachs Legion engages the posterior glenoid rim. A shaver and raspier are used to debride the reverse Hill Sachs lesion and prepare a bleeding bony surface for subscapularis. Subcoracoid debridement is then performed with attention paid toward clearing the space anterior to the subscapularis tendon to facilitate future suture retrieval. A spinal needle is inserted percutaneously through the subscapularis tendon at the level of the reverse Hill Sachs lesion and a PDS suture is passed and retrieved through the cannula in the anterior inferior portal. A PDS suture is used to shuttle a fiber tape suture and exit in the anterior surface of the subscapular is retrieved with a fiber wire grasper through the interior inferior portal. The fiber wire limbs are loaded into a four point swivel lock anchor which is inserted into the prepared reverse Hill Sachs lesion in standard fashion. The fiber tape sutures are tensioned to pull the subscapularis into the reverse Hill Sachs lesion filling the void that was previously present. The sutures are then cut flush and the dynamic exam can be performed to reassess stability.

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