82 – ARTHROSCOPIC “HILL-SACHS REMPLISSAGE”: CAPSULOTENODESIS HEALING AND RANGE OF MOTION IN 29 PATIENTS AT SHORT-TERM FOLLOW-UP

Abstract

Purpose: The “Hill-Sachs Remplissage” (HSR) is a procedure used in the treatment of anterior shoulder instability associated with an engaging Hill-Sachs (HS) defect. It consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon within the defect. There is currently no evidence that the capsule and tendon heal in the humeral bone defect. Our hypotheses were

1. that the capsulotenodesis heals in the HS defect and fills at least 50% of its area; and,

2. that limitation of range of motion compared to the non-operated shoulder would be minimal.

Method: Prospective clinical study. Inclusion criteria:

1. recurrent anterior shoulder instability;

2. engaging HS lesion.

Exclusion criteria:

1. glenoid bone loss;

2. rotator cuff tear.

Twenty-nine patients underwent an arthroscopic Bankart repair plus HSR. Clinical assessment at a mean follow up of 13.1 months (range 6 to 32 months) consisted of a structured interview and detailed physical examination including range of motion compare to the contralateral shoulder and instability signs. Range of motion was analyzed in two groups according to length of follow-up, Group 1 with less than 12 months follow-up (14 patients); and Group 2 with greater than 12 months follow-up (15 patients). Either a CT arthrogram (25 patients) or an Arthro-MRI (2 patient) was performed at a minimum of six months postoperatively. Four orthopaedic surgeons analyzed the images independently to determine the percentage of healing of the capsulotenodesis.

Results: There was no recurrence of instability at the latest follow-up. There was no statistically significant deficit in forward elevation in either group. Group 1 patients had statistically significant mean deficits as compared to the contralateral side of 15 degrees of external rotation in adduction (ER1), 15 degrees of external rotation at 90 degrees of abduction (ER2), and 1.1 points of internal rotation in adduction according to the Constant score system (ER1). Group 2 patients had statistically significant mean deficits of 4 degrees of ER1 and 11 degrees of ER2, with no significant difference in IR1. There was healing of the capsulotenodesis within the bone defect in all twenty-seven patients. The bone defect was filled more than 75% of its surface in 22 of 29 patients (76%). The remaining seven had between 50 and 75% filling (24%). There was no defect filling of less than 50% in this study.

Conclusion: We demonstrated greater than 50% HS defect filling in all patients in our series after an arthroscopic “Hill-Sachs Remplissage” and filling > 75% in 22 of 29 (76%). Modest deficits of external rotation were demonstrated at greater than 12 months follow-up. While these results suggest that the technical goal of HS defect filling is achievable, longer term studies are necessary to establish whether there is an association between the rate of healing, the functional impairment of external rotation and clinical outcomes.