Arthroscopic remplissage: a valuable adjunct to arthroscopic Bankart’s repair in shoulder instability
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210634Keywords:
Arthroscopic Remplissage, Bankart’s lesion, Hill sach’s lesionAbstract
Current study present results of arthroscopic shoulder stabilisation surgery. 46 consecutive patients with recurrent anterior shoulder dislocations and less than 25% Glenoid bone loss were treated with arthroscopic surgery in 2017-2020. Arthroscopic repair of Bankart’s lesion with capsular shift was performed in each. In 8 patients, where the Hill sach’s lesion was “off track” or “engaging”, arthroscopic remplissage was performed along with arthroscopic Bankart’s repair. There was no recurrence of shoulder instability after a mean follow up of 1 year. This included the non-engaging Hill sach’s group (treated with Bankart’s repair) as well as the engaging or off track Hill sach’s group (treated with Bankart’s repair and remplissage). All patients went on to obtain full forward flexion, full abduction and internal rotation. The Bankart’s and remplissage group had a mean of 8 degrees restriction of external rotation. SST scores and oxford scores had improved considerably on follow up in both groups Arthroscopic shoulder surgery provides a safe and reliable option in the management of recurrent shoulder dislocations. Arthroscopic remplissage is a useful adjunct to Bankart’s repair when treating the difficult problem of a large engaging Hill Sachs lesion.
References
Bankart AS. Recurrent or habitual dislocation of the shoulder-joint. Br Med J 1923;2:1132-3.
Lynch JR, Clinton JM, Dewing CB. Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg. 2009;18:317-28.
Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy. 2008;24: 1061-73.
Broca A, Hartmann H. Contribution a’ l’e’tude des luxations de l’e’paule. Bull Soc Anat Paris. 1890;4: 416-23.
Flower WH. On the pathological changes produced in the shoulder-joint by traumatic dislocation: as derived from an examination of all the specimens illustrating this injury in the museums of London. Available at: https://wellcomecollection.org/works/ hahatzr4. Accessed on 20 February 2020.
Hill HA, Sachs MD. The grooved defect of the humeral head. Radiol. 1940;35:690-700.
Palmer I, Widen A. The bone block method for recurrent dislocation of the shoulder joint. J Bone Joint Surg Br. 1948;30B:53-8.
Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677-94.
Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30:90-8.
Antonio GE, Griffith JF, Yu AB. First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging. 2007;26:983-91.
Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med. 1997;25:306-11.
Armitage MS, Faber KJ, Drosdowech DS. Humeral head bone defects: remplissage, allograft, and arthroplasty. Orthop Clin North Am. 2010;41:417-25.
Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984;66:1443-50.
Hawkins RJ, Angelo RL. Glenohumeral osteoarthrosis. A late complication of the Putti-Platt repair. J Bone Joint Surg Am. 1990;72:1193-7.
Flatow EL, Miniaci A, Evans PJ. Instability of the shoulder: complex problems and failed repairs: Part II. Failed repairs. Instr Course Lect. 1998;47:113-25.
Purchase RJ, Wolf EM, Hobgood ER. Hill-sachs "remplissage": an arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy. 2008;24: 723-6.
Connolly JF. Humeral head defects associated with shoulder dislocations: their diagnostic and surgical significance. Instr Course Lect. 1972;21:42-54.
Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg. 2014;23:814-20.
Koo SS, Burkhart SS, Ochoa E. Arthroscopic double-pulley remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs. Arthroscopy. 2009;25:1343-8.
Camp CL, Dahm DL, Krych AJ. Arthroscopic remplissage for engaging hill-sachs lesions in patients with anterior shoulder instability. Arthrosc Tech. 2015;4:e499-502.
