Clin Orthop Surg.  2016 Dec;8(4):428-436. 10.4055/cios.2016.8.4.428.

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

Affiliations
  • 1Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. everest@naver.com

Abstract

BACKGROUND
Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit.
METHODS
Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging.
RESULTS
The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II.
CONCLUSIONS
Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

Keyword

Joint instability; Shoulder dislocation; Bankart lesions; Hill-Sachs lesion; Remplissage; Prospective study

MeSH Terms

Adult
Arthroscopy/methods
Female
Humans
Male
Orthopedic Procedures/*methods/*statistics & numerical data
Prospective Studies
Recurrence
Shoulder/*surgery
Shoulder Dislocation/*surgery
Young Adult

Figure

  • Fig. 1 Arthroscopic finding of an inverted pear glenoid from the posterior portal.

  • Fig. 2 Arthroscopic view of a huge engaging Hill-Sachs lesion.

  • Fig. 3 The anchor is placed in the center area of the Hill-Sachs lesion.

  • Fig. 4 Anterior portal view of completed remplissage repair.

  • Fig. 5 (A) Postoperative magnetic resonance imaging: the infraspinatus and posterior capsule are well attached to Hill-Sachs lesion. (B) Oblique sagittal view.


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