Open Access
Table 3
Different methods of management of posterior shoulder instability [35].
| Procedure | Consideration |
|---|---|
| Soft tissue | |
| Reverse Bankart repair (open or arthroscopic) | Often performed in combination with an arthroscopic capsular plication, posterior-inferior capsular shift, or reverse Putti-Platt. |
| Arthroscopic capsular plication | Performed on patients with isolated unidirectional posterior instability without a true labral tear. |
| Open posterior-inferior capsular shift | The surgical option for patients with posterior-inferior subluxation with no anterior component and a functionally intact rotator interval Reverse Putti-Platt often reduces the range of motion and is thus generally not recommended for athletes requiring full range of motion. |
| Thermal capsulorrhaphy | Not recommended because of high recurrence rates. |
| Osseous | |
| Posterior bone block or posterior wedge osteotomy | Generally indicated for patients presenting with a failed capsular plication, glenoid hypoplasia, increased glenoid retroversion, or an osteochondral fracture of the glenoid cavity versus posterior glenoid bone loss. |
| McLaughlin’s procedure or Neer’s modification of McLaughlin’s | Performed on patients with locked posterior shoulder dislocation resulting from reverse Hill-Sachs lesions encompassing 25–50% of the humeral head. |
| Humeral head allograft | An alternative option to McLaughlin’s or Neer’s procedures based on the surgeon’s preference/experience; our preference is the most anatomic way to reconstruct large engaging reverse Hill-Sachs lesions. |
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