108. ARTHROSCOPIC REMPLISSAGE OF HILL-SACHS DEFECTS: AN ARTHROCT STUDY OF CAPSULE AND TENDON HEALING WITHIN THE BONY DEFECT

Abstract

Purpose of the study: Posterior fracture-impaction of the humeral head (Hill-Sachs defect or Malgainge notch) is a well-known factor of failure for arthroscopic shoulder stabilisation procedures. Recently, Wolf proposed arthroscopic posterior capsulodesis and tenodesis of the infraspinatus, or what we call in French Hill-Sachs Remplissage (filling). We hypothesised that capsule and tendon healing within the bony defect could explain the efficacy of this arthroscopic technique.

Material and methods: Prospective clinical study of a continuous series. Inclusion criteria:

1. recurrent anterior instability (dislocation or subluxation);

2. isolated “engaged” humeral defect;

3. Bankart arthroscopy and Hill-Sachs remplissage;

4. arthroCT or MRI at least 6 months after surgery.

Exclusion criteria:

1. associated bone loss in the glenoid;

2. associated rotator cuff tear.

Twenty shoulders (20 patients) met the inclusion and exclusion criteria and underwent Hill-Sachs remplissage. Four orthopaedic surgeons evaluated independently the soft tissue healing in the humeral defect. Mann-Whitney analysis was used to search for a link between rate of healing and clinical outcome.

Results: Filling of the humeral defect reached 75 to 100% in 16 patients (80%°; it was 50–75% in 4 patients. Healing was never noted less than 50%. The short-term clinical outcome (mean follow-up 11.4 months, range 6–32) showed an excellent results as assessed by the Constant score (mean 92±8.9 points) and the Walch-Duplay score (91 points). The subjective shoulder value (SSV) was 50% preoperatively and 89% at last follow-up. There were no cases of recurrent instability. This study was unable to establish a relationship between minor healing and less favourable clinical outcome.

Discussion: This study confirmed our hypothesis that arthroscopic Hill-Sachs remplissage provides a high rate of significant healing in a majority of patients. Capsule and tendon healing in the humeral defect yields significant shoulder stability via at least two mechanisms:

1. prevention of defect engagement on the anterior border of the glenoid and

2. posterior force via improved muscle and tendon balance in the horizontal plane.

Further mid- and long-term results will be needed to establish a confirmed correlation between healing and clinical outcome.