PMC8019564_01
1st patient: MRI scan showing PSD, reverse Hill-Sachs lesion, impaction involving approximately 40% of the articular surface of the humeral head, and an intact posterior glenoid rim.
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F1
Clinical examination, plain radiographs, CT, and MRI scans in both patients, confirmed a PSD with associated reverse Hill-Sachs lesion involving approximately 40% of the articular surface of the humeral head (Figures 1 and 2).
1st patient: MRI scan showing PSD, reverse Hill-Sachs, reverse Bankart lesion, intact posterior glenoid rim, intact lesser tubercle, and subscapularis tendon.
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F2
Clinical examination, plain radiographs, CT, and MRI scans in both patients, confirmed a PSD with associated reverse Hill-Sachs lesion involving approximately 40% of the articular surface of the humeral head (Figures 1 and 2).
2nd patient: CT scan confirming PSD with associated reverse Hill-Sachs lesion involving approximately 40% of the articular surface of the humeral head.
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F3
In the second patient, there was an associated healed humeral head-neck fracture malunited in approximately 20  of internal rotation (Figures 3 and 4).
2nd patient: MRI scan showing PSD, reverse Hill-Sachs, minimally displaced humeral head fracture, reverse Bankart lesion, intact posterior glenoid rim, intact lesser tubercle, and subscapularis.
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F4
In the second patient, there was an associated healed humeral head-neck fracture malunited in approximately 20  of internal rotation (Figures 3 and 4).
1st patient: Postoperative CT scan confirming the persistence of subluxation between reverse Hill-Sachs lesion and posterior Bankart lesion - after the modified McLaughlin procedure, in which only the humeral head's side was addressed.
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F5
Unfortunately, postoperative radiographs and CT scans in the first patient showed a posterior subluxation of the humeral head engaging in the posterior glenoid rim (Figure 5).
1st patient: Postoperative Right shoulder (AP) radiographs, after the second operation of shoulder arthroscopy and reverse Bankart repair with two metal anchors in posteroinferior glenoid rim.
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F6
With an arthroscopy during the same admission, posterior Bankart repair was performed, using two 3 mm Ti anchors and after the second operation, radiographs (Figure 6) and CT scan (Figure 7) confirmed joint congruence and centralization of the humeral head in the glenoid.
1st patient: Postoperative CT scan of Right shoulder, after the second operation of arthroscopy and reverse Bankart repair. After addressing both sides of the joint, the humeral head is centralized in the glenoid.
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F7
With an arthroscopy during the same admission, posterior Bankart repair was performed, using two 3 mm Ti anchors and after the second operation, radiographs (Figure 6) and CT scan (Figure 7) confirmed joint congruence and centralization of the humeral head in the glenoid.
2nd patient: Technical steps applying consecutively the combined procedure. (a) Direct assessment of reverse Hill-Sachs (through a small cut in rotator cuff interval), (b) lesser tubercle osteotomy (with the attached subscapularis tendon), (c) under direct vision from the anterior joint, application of two anchors through a stab wound posteriorly, to repair the reverse Bankart lesion, and (d) lesser tubercle transfer medially in the impaction area, and fixation with screws.
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F8
After the lesser tubercle osteotomy and before its transfer, while having an approach to the posterior glenoid, using a stab wound from posteriorly, two all-suture 2.9 mm anchors were applied to re-attach the posterior capsule (Figure 8).