Abstract
Background:
Individuals with large Hill-Sachs lesions may be prone to failure and reoccurrence following standard arthroscopic Bankart repair. Here, the Remplissage procedure may promote shoulder stability through infraspinatus capsulo-tenodesis directly into the lesion. Little biomechanicaldata about the Remplissage procedure on glenohumeral kinematics, stability, and range of motion (ROM) currently exists.
Questions/purposes:
What are the biomechanical effects of Bankart and Remplissage repair for large Hill-Sachs lesions?
Methods:
Six cadaveric shoulders were tested using a custom shoulder testing system. ROM and glenohumeral translation with applied loads in anterior-posterior (AP) and superior-inferior (SI) directions were quantified at 0° and 60° gleno-humeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40% Hill-Sachs lesion, Bankart repair, Bankart repair with Remplissage, and Remplissage repair alone.
Results:
Humeral external rotation (ER) and total range of motion (TR) increased significantly from intact after the creation of the Bankart lesion at both 0° abduction (ER +27.0°, TR +35.8°, p < 0.05) [Fig 1] and 60° abduction (ER +9.5°, TR +30.7°, p < 0.05) [Fig 2], but did not increase further with the addition of the Hill-Sachs lesion. The Bankart repair restored range of motion to intact values 0° abduction at addition of the Remplissage repair did not significantly alter range of motion from the Bankart repair alone. There were no significant changes in AP or SI translation between Bankart repair with and without Remplissage compared to the intact specimen.
Conclusions:
The addition of the Remplissage procedure for treatment of large Hill-Sachs lesions had no statistically significant effect on ROM or translation for treatment for large Hill-Sachs lesions.
Clinical Relevance: The Remplissage technique may be a suitable option for engaging Hill-Sachs lesions. Further clinical studies are warranted.
