1
|
Freshman R, Lurie B, Garcia G, Liu J. Understanding the Remplissage: History, Biomechanics, Outcomes, and Current Indications. Curr Rev Musculoskelet Med 2024; 17:282-291. [PMID: 38767839 PMCID: PMC11156820 DOI: 10.1007/s12178-024-09900-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE OF REVIEW Arthroscopic remplissage has continued to gain popularity as an adjunct to Bankart repair for patients with anterior shoulder instability. Although the original remplissage technique was described over 15 years ago, our understanding of when and how to use this procedure continues to evolve. This article provides a review of how remplissage affects shoulder biomechanics, compares clinical outcomes between remplissage and other procedures for shoulder instability, and discusses current indications for remplissage. RECENT FINDINGS Current research focuses on the use of remplissage across a wide range of glenoid bone loss. Remplissage appears effective at preventing recurrent instability in patients with glenoid bone loss up to 15% of the glenoid width. However, once glenoid bone exceeds 15%, outcomes tend to favor bony reconstruction procedures such as Latarjet. Results of biomechanical studies examining shoulder range of motion (ROM) after remplissage are mixed, though clinical studies tend to report no significant limitations in ROM when remplissage is added to a Bankart repair. Adding a remplissage to conventional Bankart repair may improve clinical outcomes and lower rates of recurrent instability without significantly altering shoulder ROM. However, surgeons should recognize its limitations in treating patients with large amounts of glenoid bone loss and should be prepared to discuss alternative procedures on a case-by-case basis. Absolute indications and contraindications for remplissage are not well defined currently and require further scientific research.
Collapse
Affiliation(s)
- Ryan Freshman
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| | - Benjamin Lurie
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA.
| | - Grant Garcia
- Proliance Surgeons Orthopedic Specialists of Seattle, 2409 N. 45Th Street, Seattle, WA, 98103 , USA
| | - Joseph Liu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA
| |
Collapse
|
2
|
Wu C, Ye Z, Lu S, Fang Z, Xu J, Zhao J. Biomechanical Analysis Reveals Shoulder Instability With Bipolar Bone Loss Is Best Treated With Dynamic Anterior Stabilization for On-Track Lesions and With Remplissage for Off-Track Lesions. Arthroscopy 2024; 40:1982-1993. [PMID: 38311260 DOI: 10.1016/j.arthro.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the biomechanical effects of augmenting Bankart repair (BR) with either remplissage or dynamic anterior stabilization (DAS) in the treatment of anterior shoulder instability with on-track or off-track bipolar bone loss. METHODS Eight fresh-frozen cadaveric shoulders were tested at 60° of glenohumeral abduction in the intact, injury, and repair conditions. Injury conditions included 15% glenoid bone loss with an on-track or off-track Hill-Sachs lesion as previously recommended. Repair conditions included isolated BR, BR with remplissage, and BR with DAS (long head of biceps transfer). The glenohumeral stability was assessed by measuring the anterior translation under 0, 10, 20, 30, 40, 50 N load and maximum load without causing instability at mid-range (60°) and end-range (90°) external rotation (ER). Maximum range of motion (ROM) was measured by applying a 2.2-N·m torque in passive ER and internal rotation. RESULTS Isolated BR failed to restore native glenohumeral stability in both on-track and off-track bipolar bone loss models. Both remplissage and DAS significantly decreased the anterior instability in the bipolar bone loss models, showing better restoration than the isolated BR. In the on-track lesions, DAS successfully restored native glenohumeral stability and mobility, whereas remplissage significantly decreased anterior translation without load (-2.12 ± 1.07 mm at 90° ER, P = .003; -1.98 ± 1.23 mm at 60° ER, P = .015). In the off-track lesions, remplissage restored native glenohumeral stability but led to significant ROM limitation (-8.6° ± 2.3° for internal rotation, P < .001; -13.9° ± 6.2° for ER, P = .003), whereas DAS failed to restore native stability at 90° ER regarding the increased anterior translation under 50 N (4.10 ± 1.53 mm, P < .001) and decreased maximum load (-13.8 ± 9.2 N, P = .021). CONCLUSIONS At time-zero, both remplissage and DAS significantly reduced residual anterior instability compared with isolated BR in the bipolar bone loss models and restored the native glenohumeral stability under most translational loads. However, remplissage could decrease the anterior translation without load for on-track lesions and may restrict ROM for off-track lesions, whereas DAS failed to restore native stability under high translational loads for off-track lesions. CLINICAL RELEVANCE DAS could be recommended to treat on-track bipolar bone loss with less biomechanical adverse effects, whereas remplissage might be the preferred procedure to address off-track bipolar bone loss for better stability.
Collapse
Affiliation(s)
- Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyi Fang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Fares MY, Daher M, Boufadel P, Haikal ER, Koa J, Singh J, Abboud JA. Arthroscopic remplissage: history, indications, and clinical outcomes. Clin Shoulder Elb 2024; 27:254-262. [PMID: 38062720 PMCID: PMC11181067 DOI: 10.5397/cise.2023.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2024] Open
Abstract
Several surgical procedures have been proposed to address anterior glenohumeral instability, which is one of the most common complaints in the general population. The remplissage, first described in early 2000s, is a procedure performed simultaneously with the arthroscopic Bankart repair to correct large, engaging Hill-Sachs lesions (HSLs). This procedure stabilizes the joint by tenodesing the infraspinatus tendon into the HSL to fill and disengage the defect. This procedure gained popularity because it has relatively low risk and is able to improve shoulder stability while being less invasive than other bone-blocking procedures. The remplissage has become a valuable add-on technique that can substantially improve outcomes in unstable patients undergoing arthroscopic Bankart repair. Nevertheless, several studies in the literature have raised concerns regarding its efficacy in critically unstable patients and the potential range of motion limitations that can arise postoperatively. Additional comparative studies and trials should be conducted to appropriately establish the role of remplissage in treating anterior instability, especially in patients with critical bone loss.
Collapse
Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Emil R. Haikal
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Jaspal Singh
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| |
Collapse
|
4
|
Villarreal-Espinosa JB, Saad Berreta R, Cotter E, Rafael Garcia J, Gonzalez Ayala S, Khan ZA, Chahla J, Verma NN. Lower Range of Recurrent Instability Rates Following Bankart Repair and Remplissage Compared to Isolated Bankart Repair in Patients With "Nonengaging/On-Track" Hill-Sachs Lesions and <20% Glenoid Bone Loss. Arthroscopy 2024:S0749-8063(24)00342-6. [PMID: 38735408 DOI: 10.1016/j.arthro.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/04/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To compare recurrent instability and return-to-sport rates along with external rotation differences between on-track (nonengaging) Hill-Sachs lesion patients undergoing either an isolated Bankart repair (IBR) or a Bankart repair augmented with a remplissage procedure (B+R). METHODS A search was conducted using 3 databases (PubMed, EMBASE, CINAHL) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only clinical comparative (level of evidence I-III) studies were considered for inclusion. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria. RESULTS Six level of evidence III studies, totaling 537 patients (202 B+R and 335 IBR) were included for analysis. All patients had <20% glenoid bone loss and a nonengaging, on-track Hill-Sachs lesion. At a median final follow-up of 34.7 months, recurrent dislocation rates ranged from 0% to 7.7% and 3.5% to 30% in the B+R and IBR groups, respectively. Moreover, subjective instability and revision surgery rates presented lower ranges in the B+R upon comparison with the IBR cohort (0%-32% vs 5%-71.4% and 0%-5% vs 0%-35%, respectively). Furthermore, return to preinjury level of sports ranged from 64% to 100% in the remplissage-augmented group and 50% to 90% in the IBR cohort. Postoperative external rotation at side varied from 50° to 63° in the B+R and 55° to 63° in the IBR arm. Additional subgroup analysis revealed recurrent dislocation rates in athletes and patients with near-track Hill-Sachs lesions undergoing remplissage augmentation to be 0% to 5% and 2% to 47% while ranging from 8.8% to 30% and 9% to 66% for IBR patients, respectively. CONCLUSIONS Upon qualitative analysis, ranges of recurrent instability measures, including recurrent dislocation rates, are higher in patients undergoing IBR in comparison to B+R. Activity level influences outcomes as athletes were found to have a higher range of recurrent dislocation rates in the IBR group. The addition of remplissage showed a higher range of return-to-sport rates with comparable postoperative external rotation between groups. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
Collapse
Affiliation(s)
| | - Rodrigo Saad Berreta
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric Cotter
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - José Rafael Garcia
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Zeeshan A Khan
- Rush University Medical College, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois, U.S.A..
| |
Collapse
|
5
|
Zhang F, Liao W, Chen X, Zhang B, Xu L, Wang X, Zhu Y, Fu Y, Xiong W, Song S, Sheng X, Gao H, Lai S, Zhang Q. Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage With Bankart Repair in Abduction-External Rotation Position. Am J Sports Med 2024; 52:603-612. [PMID: 38288525 DOI: 10.1177/03635465231220373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hill-Sachs lesion (HSL) remplissage with Bankart repair (RMBR) provides a minimally invasive solution for treating HSLs and glenoid bone defects of <25%. The infraspinatus tendon is inserted into the HSL during the remplissage process, causing the infraspinatus to shift medially, leading to an unknown effect on glenohumeral alignment during the resting abduction-external rotation (ABER) and muscle-active states. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the possible check-rein effect and muscle-active control in stabilizing the glenohumeral joint after RMBR in vivo. We hypothesized that the check-rein effect and active control would stabilize the glenohumeral joint in the ABER position in patients after RMBR. STUDY DESIGN Controlled laboratory study. METHODS We included 42 participants-22 patients in group A who met the inclusion criteria after RMBR and 20 healthy participants in group B without shoulder laxity. Three-dimensional magnetic resonance imaging was performed to analyze the alignment relationship of the glenohumeral joint with and without muscular activity. Ultrasonic shear wave elastography was used to evaluate the elastic properties of the anterior capsule covered with the anterior bands of the inferior glenohumeral ligament. RESULTS Patients who underwent RMBR demonstrated more posterior (-1.81 ± 1.19 mm vs -0.76 ± 1.25 mm; P = .008) and inferior (-1.05 ± 0.62 mm vs -0.45 ± 0.48 mm; P = .001) shifts of the humeral head rotation center and less anterior capsular elasticity (70.07 ± 22.60 kPa vs 84.01 ± 14.08 kPa; P = .023) than healthy participants in the resting ABER state. More posterior (-3.17 ± 0.84 mm vs -1.81 ± 1.19 mm; P < .001) and less-inferior (-0.34 ± 0.56 mm vs -1.05 ± 0.62 mm; P < .001) shifts of the humeral head rotation center and less anterior capsular elasticity (36.57 ± 13.89 kPa vs 70.07 ± 22.60 kPa; P < .001) were observed in the operative shoulder during muscle-active ABER than in resting ABER states. CONCLUSION The check-rein effect and muscle-active control act as stabilizing mechanisms in RMBR during the ABER position. CLINICAL RELEVANCE Stabilizing mechanisms in RMBR during the ABER position include the check-rein effect and muscle-active control.
Collapse
Affiliation(s)
- Fei Zhang
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weixiong Liao
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianghui Chen
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baoxiang Zhang
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lin Xu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaolin Wang
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yaqiong Zhu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yangmu Fu
- Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wentao Xiong
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shoulong Song
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianhao Sheng
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huayi Gao
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shengwei Lai
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiang Zhang
- Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
6
|
Freshman RD, Zhang AL, Benjamin Ma C, Feeley BT, Ortiz S, Patel J, Dunn W, Wolf BR, Hettrich C, Lansdown D, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Bravman JT, Cox CL, Cvetanovich GL, Grant JA, Frank RM, Jones GL, Kuhn JE, Mair SD, Marx RG, McCarty EC, Miller BS, Seidl AJ, Smith MV, Wright RW. Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort. Orthop J Sports Med 2023; 11:23259671231206757. [PMID: 37900861 PMCID: PMC10612462 DOI: 10.1177/23259671231206757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. Purpose To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. Results A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Conclusion Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
Collapse
Affiliation(s)
- Ryan D. Freshman
- Investigation performed at the University of California–San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Jhillika Patel
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Warren Dunn
- Fondren Orthopedic Group, Houston, Texas, USA
| | - Brian R. Wolf
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Drew Lansdown
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | | | - Julie Y. Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | - Charles L. Cox
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John A. Grant
- MedSport, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Grant L. Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John E. Kuhn
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Eric C. McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Adam J. Seidl
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rick W. Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
7
|
Paul RW, Reddy MP, Onor G, Sonnier JH, Zareef U, Bishop ME, Erickson BJ. Bankart Repair With or Without Concomitant Remplissage Results in Similar Shoulder Motion and Postoperative Outcomes in the Treatment of Shoulder Instability. Arthrosc Sports Med Rehabil 2022; 5:e171-e178. [PMID: 36866319 PMCID: PMC9971860 DOI: 10.1016/j.asmr.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare the results of patients who underwent Bankart repair with or without concomitant remplissage for treatment of shoulder instability. Methods All patients who underwent shoulder stabilization for shoulder instability from 2014 to 2019 were evaluated. Patients who underwent remplissage were matched to those patients who received no remplissage based on sex, age, body mass index, and date of surgery. Glenoid bone loss and presence of an engaging Hill-Sachs lesion were quantified by 2 independent investigators. Postoperative complications, recurrent instability, revision, shoulder range of motion (ROM), return to sport (RTS), and patient-reported outcome measures (Oxford Shoulder Instability, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores) were compared between groups. Results Overall, 31 patients who underwent remplissage were identified and matched to 31 patients who received no remplissage at a mean follow-up of 2.8 ± 1.8 years. Glenoid bone loss was similar between groups (11% vs 11%, P = .956); however, engaging Hill-Sachs lesions were more prevalent in the patients who underwent remplissage than the patients who received no remplissage (84% vs 3%, P < .001). There were no significant differences in rates of redislocation (remplissage: 12.9% vs no remplissage: 9.7%), subjective instability (45.2% vs 25.8%), reoperation (12.9% vs 0%), or revision (12.9% vs 0%) between groups (all P > .05). Also, there were no differences in RTS rates, shoulder range of motion, or patient-reported outcome measures (all P > .05). Conclusions If a patient is indicated for Bankart repair with concomitant remplissage, surgeons may expect shoulder motion and postoperative outcomes similar to those of patients without engaging Hill-Sachs lesions who undergo Bankart repair without concomitant remplissage. Level of Evidence Therapeutic case series, level IV.
Collapse
Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.,Hackensack Meridian School of Medicine, Nutley, New Jersey, U.S.A
| | - Manoj P. Reddy
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Gabriel Onor
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Usman Zareef
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | | | - Brandon J. Erickson
- Rothman Orthopaedic Institute, New York, New York, U.S.A.,Address correspondence to Brandon J. Erickson, M.D., Rothman Orthopaedic Institute, 645 Madison Ave., 3rd and 4th floors, New York, NY 10022.
| |
Collapse
|
8
|
Ganokroj P, Whalen RJ, Provencher CMT. Editorial Commentary: For Shoulder Hill-Sachs Lesion Remplissage, Medial Anchor Position Must Be Optimized to Achieve Stability Yet Minimize External Rotation Loss. Arthroscopy 2022; 38:2984-2986. [PMID: 36344057 DOI: 10.1016/j.arthro.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
An off-track Hill-Sachs lesion (HSL) is a significant risk factor for recurrent shoulder instability after arthroscopic Bankart repair. Bankart repair combined with remplissage can better restore shoulder stability versus isolated Bankart repair when treating a combined Bankart lesion and off-track HSL. However, remplissage may be nonanatomic and associated with limitation of shoulder external rotation (ER), especially when the arm is in a 90° shoulder abduction position. Excessive medial placement of remplissage anchors is associated with postoperative ER loss and increased glenohumeral cartilage degeneration. The use of 2 medial anchors results in lower articular forces. Thus, in patients with shoulder instability, we recommend using 2 remplissage anchors in those with a Bankart lesion plus an off-track HSL. The anchors should be placed medially to achieve stability-but not so medial as to result in postoperative stiffness and significant ER loss.
Collapse
|
9
|
Feng S, Li H, Chen Y, Chen J, Ji X, Chen S. Bankart Repair With Remplissage Restores Better Shoulder Stability Than Bankart Repair Alone, and Medial or Two Remplissage Anchors Increase Stability but Decrease Range of Motion: A Finite Element Analysis. Arthroscopy 2022; 38:2972-2983.e3. [PMID: 35817378 DOI: 10.1016/j.arthro.2022.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of the number and location of anchors for remplissage on postoperative glenohumeral biomechanics. METHODS A biomechanical study was conducted involving finite element model constructed based on data from the intact glenohumeral joint. Seven models were established, including a normal model, a model of Bankart lesion combined with "off-track" Hill-Sachs lesion, a model of Bankart repair alone, and 4 models of Bankart repair with remplissage based on different remplissage anchor numbers and locations. The effects of the number and location of the remplissage anchors on glenohumeral stability were studied through calculation and comparison of (1) the stress and its distribution on the joint capsule, cartilage, labrum and anchors as well as (2) the displacement of the humeral head. RESULTS Finite element analysis demonstrated that contact stress on the glenohumeral cartilage decreased when medial or 2 anchors were used and was minimized in the combined repair model with 2 medial anchors. The stress on remplissage anchors was greater when the anchors were placed medially. The humeral head displacement was maximized in the combined lesion model. The combined repair models with 2 medially placed anchors showed the largest slope on the force-displacement curve, indicating the largest strain on the humeral head. CONCLUSIONS Based on a finite element analysis, Bankart repair with remplissage restored better shoulder stability compared with Bankart repair alone in the treatment of anterior shoulder instability involving Bankart lesion combined with "off-track" Hill-Sachs lesion. When the anchor for remplissage was medially placed or 2 anchors were used, the stability of the glenohumeral joint increased but with a loss of range of motion. CLINICAL RELEVANCE The results of this study will assist in choosing the number and location of anchors for remplissage during shoulder stabilization surgery although with some limitations.
Collapse
Affiliation(s)
- Sijia Feng
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China
| | - Huizhu Li
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuzhou Chen
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xiaoxi Ji
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China.
| | - Shiyi Chen
- Department of Sports Medicine, Sports Medicine Institute of Fudan University, Huashan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
10
|
Horinek JL, Menendez ME, Callegari JJ, Narbona P, Lädermann A, Barth J, Denard PJ. Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair. Arthrosc Sports Med Rehabil 2022; 4:e1283-e1289. [PMID: 36033173 PMCID: PMC9402416 DOI: 10.1016/j.asmr.2022.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Treatment for patients with anterior glenohumeral instability with subcritical bone loss is evolving. The purpose of this study was to compare 2-year outcomes of arthroscopic Bankart repair with and without Hill–Sachs remplissage in patients with <15% glenoid bone loss. Methods A multicenter retrospective study was performed on a consecutive series of patients who underwent primary isolated arthroscopic Bankart repair (IBR) or arthroscopic Bankart repair with remplissage (REMP) by 4 shoulder specialists between 2013 and 2019. Range of motion (ROM) and patient-reported outcomes (PROs) were collected at baseline and 2 years postoperative: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Recurrence, return to sport, satisfaction, complications, and revisions also were reviewed. Results A total of 123 patients were available, including 75 IBR and 48 REMP. Baseline demographics, activity, ROM, and PROs were similar. Mean glenoid bone loss (2.5% vs 6.1%: P < .001) was greater in REMP, although the number of on-track lesions was similar (98.7% vs 93.8%: P = .298). WOSI scores were improved for REMP (196.5 vs 42.7: P = .004), but otherwise no difference in postoperative PROs or ROM. Differences between cohorts did not reach significance in return to sport (73% vs 83%: P = .203), recurrence (9.3% vs 2.1%: P = .148), or revisions (6.8% vs 2.1%: P = .403). For on-track lesions there were 6 recurrences in IBR (6 of 74; 8.1%) and 1 recurrence in REMP (1 of 45; 2.2%). Conclusions Despite slightly worse pathology, patients with subcritical bone loss who undergo REMP experience similar short-term postoperative function to isolated IBR. Recurrence, revision, and return to sport favored REMP but this study was underpowered to show statistical significance. Recurrence was common following IBR, despite subcritical glenoid bone loss and primarily on-track lesions, suggesting that REMP can be considered in on-track lesions. Level of Evidence III, retrospective comparative study.
Collapse
|
11
|
Kim DH, Kim JY, Park J, Talwar M, Jenkins S, Gardner B, McGahan P, Chen JL. Combined Double-Pulley Remplissage and Bankart Repair. Arthrosc Tech 2022; 11:e419-e425. [PMID: 35256986 PMCID: PMC8897634 DOI: 10.1016/j.eats.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023] Open
Abstract
The use of arthroscopic Bankart repair to treat anterior shoulder instability has become increasingly widespread. However, high rates of recurrent instability within the presence of glenohumeral bony defects, specifically Hill-Sachs lesions, have well documented a key concern regarding the arthroscopic Bankart repair process. Our technique describes the pairing of a remplissage to fill the Hill-Sachs lesion with the Bankart repair, preventing loss in shoulder stiffness and stability. This technique involves a double-pulley-combined remplissage and Bankart repair to maintain a low-failure, minimally invasive procedure.
Collapse
Affiliation(s)
- Dong Hyeon Kim
- Address correspondence to Dong Hyeon Kim, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St., Ste. 400, San Francisco, CA, 94108, U.S.A.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Diop A, Maurel N, Blancheton A, Bastard C, Kavakelis T, Nourissat G. The biomechanical effect of injury and repair of the inferior glenohumeral ligament on glenohumeral stability: Contribution of the posterior band. Clin Biomech (Bristol, Avon) 2022; 91:105540. [PMID: 34879318 DOI: 10.1016/j.clinbiomech.2021.105540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many surgical procedures are proposed to manage shoulder instability with recurrent dislocation but there is still a high rate of failure or complications. Repairs are often limited to anterior part of inferior glenohumeral ligament but some authors are reporting better clinical results if its posterior band is also repaired. This biomechanical study aimed to investigate the impact of a supplementary posterior injury compared with an isolated anterior injury and to analyze the contribution of a posterior repair of the inferior glenohumeral ligament compared with an isolated anterior repair. METHODS Six fresh-frozen cadaveric shoulders were tested intact and after both anterior and posterior injuries and repairs of the inferior glenohumeral ligament. Shoulders were placed at 90° of humerothoracic elevation in scapular plane and 60° of external rotation. Joint stability was analyzed by successively applying anterior, posterior, inferior and superior glenohumeral displacements and measuring the resulting forces or by applying an anteroinferior loading and measuring three-dimensional head displacements. Maximal range of external rotation was also measured. FINDINGS Combined anterior and posterior injuries of the inferior glenohumeral ligament were necessary to obtain significant instabilities in anterior and inferior directions. A complementary repair of the posterior band improved the biomechanical stability of the glenohumeral joint compared to an isolated anterior repair when anterior and posterior bands are injured. No reduction of external rotation was observed after repairs compared to intact condition. INTERPRETATION These results show the biomechanical interest of this surgical procedure and contribute to document its relevance in clinical practice.
Collapse
Affiliation(s)
- Amadou Diop
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Nathalie Maurel
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Aurore Blancheton
- Clinique des Maussins, 67, rue de Romainville, 75019 Paris, France; CHU Nantes, 1, place Alexis Ricordeau, 44000 Nantes, France
| | - Claire Bastard
- Clinique des Maussins, 67, rue de Romainville, 75019 Paris, France; Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor, 1 rue Gustave Eiffel, 94000 Créteil, France
| | - Théo Kavakelis
- Clinique des Maussins, 67, rue de Romainville, 75019 Paris, France; Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France
| | | |
Collapse
|
13
|
Tanpowpong T, Moonwong S, Itthipanichpong T. Arthroscopic All-Inside Suture Bridge for Remplissage Procedure Treating Off-Tracking Hill-Sachs Lesions in Anterior Shoulder Instability. Arthrosc Tech 2021; 10:e2311-e2317. [PMID: 34754739 PMCID: PMC8556669 DOI: 10.1016/j.eats.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Hill-Sachs lesions are significantly correlated with recurrent anterior shoulder instability. The remplissage procedure is designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterosuperior capsule in patients with off-track Hill-Sachs lesions. This Technical Note describes an arthroscopic all-inside suture bridge to gain more footprint contact area and tissue compression to improve healing. Moreover, it does not have the necessity of going through the subacromial space to retrieve and tie the sutures. Thus, the procedure reduces the operative time and improves reproducibility.
Collapse
Affiliation(s)
| | | | - Thun Itthipanichpong
- Address correspondence to Thun Itthipanichpong, M.D., Department of Orthopaedics, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| |
Collapse
|
14
|
Feng S, Chen M, Chen J, Li H, Chen J, Chen S. Patient Outcomes and Fear of Returning to Sports After Arthroscopic Bankart Repair With Remplissage. Orthop J Sports Med 2021; 9:23259671211001775. [PMID: 33997069 PMCID: PMC8111275 DOI: 10.1177/23259671211001775] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Although Bankart repair with remplissage is commonly performed to treat anterior shoulder instability, there is limited information on specific outcomes or patients’ fears regarding return to sports (RTS). Purpose: To study recurrence rates, pain, shoulder function, active range of motion (ROM), RTS rate, and patients’ fears and expectations for RTS after arthroscopic Bankart repair with remplissage for anterior shoulder instability. We compared these outcomes with those after Bankart repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was carried out between 2007 and 2017 among patients who underwent arthroscopic Bankart repair with remplissage (group BR) and Bankart repair alone (group B). At the final follow-up, outcomes including recurrence, pain, shoulder function, active ROM, RTS rate, and fear toward RTS were assessed. The specific outcomes for RTS were evaluated based on 3 levels: return to normal life, RTS at any level (RTSA), and RTS at previous level (RTSP). Results: A total of 70 patients were included (29 in group BR and 41 in group B) with a mean 67.2 months of follow-up. Group BR demonstrated a significantly lower recurrence rate than did group B (0 vs 22.0%, respectively; P = .007) as well as higher postoperative Rowe score (92.8 ± 7.1 vs 83.3 ± 16.2, respectively; P = .005). There were no differences between the groups in postoperative visual analog scale for pain score, American Shoulder and Elbow Surgeons score, Oxford Shoulder Instability Score, or active ROM. The rates of RTSA (100% vs 84.2%; P = .03) and RTSP (77.8% vs 50.0%; P = .02) were higher in group BR than in group B, respectively, and significantly fewer patients in group BR reported fear of RTS (40.7% vs 63.2%; P = .04). Conclusion: In this study, recurrence rate, pain, shoulder function, active ROM, and RTS rate were satisfactory after arthroscopic Bankart repair with remplissage. Patients who underwent this procedure reported less fear toward RTS and higher rates of RTSA and RTSP than did those who undergo Bankart repair alone.
Collapse
Affiliation(s)
- Sijia Feng
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mo Chen
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Sports Medicine Institute of Fudan University, Department of Orthopaedic Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
15
|
Subramanian KN, Channabasappa Eswarappa D, Senthilnathan GP, Subramanian M, Sellappan R. Arthroscopic nomenclature of capsulolabral appearances in anterior shoulder dislocation. J Orthop 2021; 25:120-123. [PMID: 34025054 DOI: 10.1016/j.jor.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Objectives To study the intraoperative morphology of the glenoid labrum and capsule in recurrent shoulder dislocation and to study the relationship between the number of dislocations and the changes in the glenoid and labrum. Methods Over a period of 18 months, 108 patients with traumatic anterior dislocations were included in the study, of which 102 men and 6 women with mean age of 33.4yrs range from 18 to 45. The patients with bony bankart, other labral lesions, ligamentous laxity, SLAP tear were excluded from the study. All the patients underwent arthroscopic bankart repair. We have classified the morphology of labrum and capsule on their appearance intraoperatively. Labrum is named as Normal, Desiccated or Shredded and Capsule as Normal or Damaged. Results Six varieties of appearances were observed. Namely, Normal capsule and Normal labrum (NN), Normal capsule and Desiccated labrum (ND), Normal capsule and Shredded labrum (NS), Damaged capsule and Normal labrum (DN), Damaged capsule and Desiccated labrum(DD), Damaged capsule and Shredded labrum(DS). Among them, DD (33.3%) and DS (29.6%) variety had highest number of dislocations suggesting the labrum and capsule lose normal anatomy with more recurrence of dislocations. Conclusion These findings support that reproducing normal anatomy after surgical repair is possible when the intervention is done sooner than later. Level of evidence III.
Collapse
|
16
|
Pandey V, Gangadharaiah L, Madi S, Acharya K, Nayak S, Karegowda LH, Willems WJ. A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion. J Shoulder Elbow Surg 2020; 29:273-281. [PMID: 31447283 DOI: 10.1016/j.jse.2019.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lone Bankart repair is associated with high rates of recurrence, especially in off-track Hill-Sachs (HS) lesion. The objective of the study was to assess the impact of remplissage in off-track HS lesion influencing the rate of redislocation and range of motion (ROM) of the shoulder. MATERIAL AND METHOD We retrospectively reviewed 136 patients for arthroscopic Bankart repair without remplissage (group 1, n = 77) or with remplissage (group 2, n =59) for recurrent anterior dislocation of the shoulder with glenoid bone loss of <25%. Further subgroups of on- and off-track HS lesion were based on computed tomographic assessment. At a minimum follow-up of 2 years; patients were evaluated for functional scores (Rowe, Constant-Murley, Western Ontario Shoulder Instability Index), redislocations, and ROM. RESULTS At a mean follow-up of 54 and 44 months in group 1 and 2, respectively, there was no difference in postoperative functional scores. There were significantly more dislocations in patients with Bankart repair with off-track lesion than in patients with Bankart repair with on-track lesion (P = .02). There were significantly fewer redislocations in patients with off-track lesion who underwent Bankart repair and remplissage than in those who did not undergo remplissage (P = .0007). Compared with group 1 patients, those in group 2 revealed a statistically significant loss of ROM. CONCLUSIONS Although a nonremplissaged off-track HS lesion remains an important risk factor for recurrent instability, remplissage also results in significant loss of shoulder ROM compared with those who do not undergo remplissage.
Collapse
Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Lohith Gangadharaiah
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kiran Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shalini Nayak
- School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal Karnataka, India
| | | | - W Jaap Willems
- Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Lemmex D, Cárdenas G, Ricks M, Woodmass J, Chelli M, Boileau P. Arthroscopic Management of Anterior Glenoid Bone Loss. JBJS Rev 2020; 8:e0049. [DOI: 10.2106/jbjs.rvw.19.00049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
18
|
Chakrabarti MO, Gwosdz J, Rosinski A, Guzman AJ, McGahan PJ, Chen JL. Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability. Arthrosc Tech 2019; 8:e527-e533. [PMID: 31334006 PMCID: PMC6620479 DOI: 10.1016/j.eats.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/25/2019] [Indexed: 02/03/2023] Open
Abstract
Hill-Sachs lesions of the humeral head are associated with recurrent anterior shoulder instability. Arthroscopic double-pulley remplissage has emerged as the leading alternative to the open Latarjet procedure to address recurrent shoulder instability with comparable recurrence rates and favorable complication rates. This Technical Note describes our adaptation of the double-pulley remplissage technique by using 2 portals, with the anterior portal used as the viewing portal and suture passage through the posterior portal. This technique eliminates the need for a lateral percutaneous portal, consequently minimizing operative time and postoperative morbidity. Furthermore, using the anterior portal as the viewing portal allows for direct visualization of the reduction of the infraspinatus into the Hill-Sachs defect. The drawback of this technique is that there is no view of the subacromial space during knot tying.
Collapse
Affiliation(s)
- Moyukh O. Chakrabarti
- Address correspondence to Moyukh O. Chakrabarti, M.B.B.S., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
| | | | | | | | | | | |
Collapse
|
19
|
Remplissage With Bankart Repair in Anterior Shoulder Instability: A Systematic Review of the Clinical and Cadaveric Literature. Arthroscopy 2019; 35:1257-1266. [PMID: 30954117 DOI: 10.1016/j.arthro.2018.10.117] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical and biomechanical results of an arthroscopic Bankart repair alone with an arthroscopic Bankart repair combined with remplissage. METHODS A literature search was performed on May 1, 2018, in PubMed and Embase for studies comparing an isolated arthroscopic Bankart repair and an arthroscopic Bankart repair with remplissage. The quality of the studies was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Cochrane Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) checklist. Results regarding failures, biomechanical properties, and shoulder function were extracted. RESULTS We included 13 studies (6 clinical and 7 biomechanical studies), and their overall quality was very low to low. In the biomechanical studies, adding a remplissage to the Bankart repair prevented engagement in all cadavers, resulted in more stiffness, and impaired the range of motion. Among clinical studies, all reported lower recurrence rates and most showed better shoulder function after a Bankart repair with remplissage compared with an isolated Bankart repair. The return-to-sport rates were mostly similar, whereas the loss of range of motion was often higher after a Bankart repair with remplissage. CONCLUSIONS The addition of a remplissage procedure to a Bankart repair for managing small to medium Hill-Sachs lesions might be beneficial in reducing the risk of recurrent instability and improving shoulder function, without increasing the risk of complications. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.
Collapse
|
20
|
Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 2019; 35:617-628. [PMID: 30612762 DOI: 10.1016/j.arthro.2018.09.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the clinical outcomes and biomechanical data supporting the use of the remplissage procedure. METHODS A query of the Embase, PubMed, Scopus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from 2000 to 2017. Data were extracted from included studies for a qualitative review of both clinical and biomechanical outcomes. RESULTS After review, 18 clinical and 10 biomechanical studies were available for analysis; 10 of 18 clinical studies (55.6%) were Level IV evidence. Within the clinical studies, there were 567 patients (570 shoulders) evaluated with follow-up ranging from 6 to 180 months. Overall, 5.8% of shoulders (33 of 570) displayed recurrent instability after arthroscopic remplissage. Of the shoulders with recurrent instability, 42.4% of shoulders (14 of 33) underwent further surgical management. In all studies evaluating pre- and postoperative patient-reported outcomes, the arthroscopic remplissage procedure improved patient-reported outcomes a statistically significant amount postoperatively. Within individual clinical studies, external rotation with the arm in neutral was the most consistently limited range of motion (ROM) parameter, with deficits compared with the contralateral shoulder ranging from 9° to 14°. Biomechanical analysis appeared to corroborate the clinical results, although significant conclusions were limited by heterogeneity of reporting. CONCLUSIONS Arthroscopic remplissage performed in conjunction with arthroscopic Bankart repair is a safe and effective procedure for patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss. Although both the included clinical and biomechanical studies would suggest minimal changes in glenohumeral ROM following the remplissage procedure, strong conclusions are limited by the heterogeneity in reporting ROM data and lack of comparative studies. LEVEL OF EVIDENCE IV, systematic review.
Collapse
|
21
|
Williamson P, Mohamadi A, Ramappa AJ, DeAngelis JP, Nazarian A. Shoulder biomechanics of RC repair and Instability: A systematic review of cadaveric methodology. J Biomech 2019; 82:280-290. [DOI: 10.1016/j.jbiomech.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 01/11/2023]
|
22
|
Long-term outcome of arthroscopic remplissage in addition to the classic Bankart repair for the management of recurrent anterior shoulder instability with engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc 2019; 27:305-313. [PMID: 30374572 DOI: 10.1007/s00167-018-5261-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The evaluation of the long-term outcome of the arthroscopic remplissage performed in addition to the classic Bankart repair for the primary management of recurrent anterior shoulder instability with engaging Hill-Sachs lesion without inverted pear appearance of the glenoid during arthroscopy. METHODS During a 6-year period, from 2007 to 2012, 65 patients whose average age was 30.1 ± 7.6 years were operated on in our department and satisfied the inclusion criteria of this study. They all had a positive apprehension sign preoperatively. Among them, 51 patients (82%) were available for long-term evaluation. The mean follow-up period was 8.1 ± 1.8 years (range 5.6-10.6). RESULTS Three patients (5.6%) had suffered a new dislocation. The remaining patients (94.4%) were satisfied with the surgical result and returned to their previous daily activities, whereas 71% continued to participate in sports without restrictions. The ASES score increased from 72.5 (range 18-100) preoperatively to 100 (range 85-100) postoperatively (p < 0.01). The modified Rowe score increased from 40 (range 15-70) to 100 (range 70-100) (p < 0.001), and the Oxford Instability score from 29 (range 9-47) to 48 (range 36-48) (p < 0.001). No significant restriction in the shoulder range of motion was documented. CONCLUSIONS The combination of the arthroscopic remplissage with the classic Bankart repair was proven to be a safe and effective procedure for the treatment of "engaging" Hill-Sachs lesions without inverted pear appearance of the glenoid. This combination has long-term outcomes in terms of the recurrence rate and does not significantly influence the range of motion of the shoulder. LEVEL OF EVIDENCE Therapeutic Study-Case series with no comparison group, Level IV.
Collapse
|
23
|
Park I, Park CJ, Lee JH, Hyun HS, Park JY, Shin SJ. Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20. Arthroscopy 2018; 34:2287-2293. [PMID: 29804952 DOI: 10.1016/j.arthro.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%. METHODS A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2 years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented. RESULTS The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P = .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P = .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P = .01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P = .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I. CONCLUSIONS Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- In Park
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Chan-Jae Park
- Department of Orthopedic Surgery, Bumin Haeundae Hospital, Busan, Republic of Korea
| | - Jae-Hoo Lee
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Park
- Center for Shoulder, Elbow and Sports Medicine, Neon Orthopaedic Clinic, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
24
|
Miyamoto R, Yamamoto A, Shitara H, Ichinose T, Shimoyama D, Sasaki T, Hamano N, Kobayashi T, Osawa T, Takagishi K. Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability. Open Orthop J 2017; 11:1268-1276. [PMID: 29290865 PMCID: PMC5721320 DOI: 10.2174/1874325001711011268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 07/30/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022] Open
Abstract
Purpose We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation. Methods Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively. Results Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up. Conclusion Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.
Collapse
Affiliation(s)
- Ryosuke Miyamoto
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | - Atsushi Yamamoto
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | - Hitoshi Shitara
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | - Tsuyoshi Ichinose
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | | | - Tsuyoshi Sasaki
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | - Noritaka Hamano
- Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
| | - Tsutomu Kobayashi
- Takasaki University of Health and Welfare - Physical Therapy, Takasaki, Gunma, Japan
| | - Toshihisa Osawa
- National Hospital Organization Takasaki General Medical Center - Orthopaedic Surgery, Takasaki, Gunma, Japan
| | - Kenji Takagishi
- St. Pierre Hospital - Orthopaedic Surgery, Takasaki, Gunma, Japan
| |
Collapse
|
25
|
Werner BC, Chen X, Camp CL, Kontaxis A, Dines JS, Gulotta LV. Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage Without Restricting Motion in the Setting of an Engaging Hill-Sachs Defect. Am J Sports Med 2017; 45:1982-1989. [PMID: 28402759 DOI: 10.1177/0363546517700860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous surgical options for the management of engaging Hill-Sachs lesions exist, of which remplissage has emerged as one of the most popular arthroscopic techniques. Remplissage is not without disadvantages, however, and has been demonstrated to potentially result in a loss of external rotation (ER) due to nonanatomic tethering of the infraspinatus tendon and a potential decrease in infraspinatus strength clinically. PURPOSE The efficacy of posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen human cadaveric shoulders were utilized for the study. After testing baseline translation and motion, 30% Hill-Sachs lesions were created in each specimen. Three experimental groups were assembled: (1) isolated Bankart repair (HSD), (2) Bankart repair with remplissage (RM), and (3) Bankart repair with posterior medial capsular plication (PL). Biomechanical testing was performed to determine anterior translation, range of motion, and Hill-Sachs engagement. Translation and motion measurements were normalized to the baseline laxity values for each specimen. RESULTS A significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both the PL and RM groups compared with the HSD group throughout most of the joint loads tested ( P < .05), but no significant differences were noted between the PL and RM groups at any load. The RM group had significantly less normalized ER at 60° of abduction compared with the HSD and PL groups ( P < .05). There were no differences in internal rotation between the groups. All 8 specimens in the HSD group engaged, while no specimens in the RM and PL groups engaged ( P < .001). CONCLUSION In a cadaveric model, medial posterior capsular plication as an adjunct to Bankart repair offers similar resistance to anterior translation and Hill-Sachs engagement as compared with remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of ER compared with remplissage without any significant limitation of internal rotation. CLINICAL RELEVANCE Posterior medial capsular plication reduces translation and engagement similarly to remplissage, without any restriction in motion.
Collapse
Affiliation(s)
- Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Xiang Chen
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Christopher L Camp
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andreas Kontaxis
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
26
|
Alexander TC, Beicker C, Tokish JM. Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion. Arthrosc Tech 2016; 5:e975-e979. [PMID: 27900256 PMCID: PMC5123989 DOI: 10.1016/j.eats.2016.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/26/2016] [Indexed: 02/03/2023] Open
Abstract
Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We present the arthroscopic remplissage technique originally described by Koo and Burkhart et al. with a modification in the percutaneous anchor placement and suture tying that is reproducible and effective. We percutaneously place 2 suture anchors, which require no additional suture passing across the tissue, to create a double pulley technique, filling the defect with posterior capsule and rotator cuff. Therefore, the Hill-Sachs defect becomes extra-articular, eliminating the potential engagement of the anterior glenoid and contribution to recurrence of instability. This technique is applicable broadly for most Hill-Sachs lesions that need addressing. By not having to pass or shuttle any suture through tissue after anchor placement and by eliminating the necessity to go subacromially to retrieve or tie suture, the technique saves time and improves reproducibility. The compression of tissue into the Hill Sachs surface area also is improved by double-reinforced suturing through the double-pulley technique. The combination of these advantages creates a sound and efficient technique for remplissage.
Collapse
Affiliation(s)
| | | | - John M. Tokish
- Address correspondence to John M. Tokish, M.D., Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 200 Patewood Drive, Suite C100, Greenville, SC 29615, U.S.A.Steadman Hawkins Clinic of the CarolinasGreenville Health System200 Patewood DriveSuite C100GreenvilleSC29615U.S.A.
| |
Collapse
|
27
|
Somford MP, Nieuwe Weme RA, van Dijk CN, IJpma FFA, Eygendaal D. Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery. ACTA ACUST UNITED AC 2016; 21:163-71. [DOI: 10.1136/ebmed-2016-110453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
28
|
Tan CHJ, Saier T, von Deimling C, Martetschläger F, Minzlaff P, Feucht MJ, Martinez H, Braun S, Imhoff AB, Burgkart R. Effect of three remplissage techniques on tendon coverage and shoulder kinematics: a navigated robotic biomechanical study. BMC Musculoskelet Disord 2016; 17:1. [PMID: 26728594 PMCID: PMC4700656 DOI: 10.1186/s12891-015-0856-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/16/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In addition to Bankart repair engaging Hill-Sachs defects in glenohumeral instability have been treated successfully with remplissage procedure. The purpose of this study was to compare three remplissage techniques regarding (I) ability of preventing Hill-Sachs defect from engaging, (II) influence on glenohumeral rotational torque, and (III) resulting tendon coverage over the Hill-Sachs defect. METHODS Standardized engaging Hill-Sachs defects and Bankart lesions were created in n = 7 fresh frozen human shoulder specimens. Besides Bankart repair three remplissage techniques (T) with double anchor position in the valley of the defect zone were studied: T1, knots tied over anchors; T2, knots tied between anchors (double-pulley); T3, knotless anchors with a suture tape. A parallel position-orientation and force-moment controlled navigated roboticsystem was used to compare prevention of Hill-Sachs defect engagement and torque [Nm]. Pressure sensitive film was used to study area of infraspinatus tendon coverage over Hill-Sachs defect [%]. RESULTS All remplissage techniques prevented engagement of the Hill-Sachs defect without showing any construct failures. Regarding humeral torque there were significant impairments observed between intact conditions and the three investigated repair techniques in 60° abduction and ≥30° external rotation (p < .04). There was no significant difference in torque between intervention groups (n.s.). With a mean coverage of 26.8 % over the defect zone the knotless suture tape technique (T3) significantly improved area of soft tissue coverage compared to the other techniques (p = .03). CONCLUSION All remplissage techniques prevented engagement of the Hill Sachs defect. With high abduction and external rotation ≥30° all techniques showed significant higher humeral torque compared to the intact specimens, while there was not one technique superior over the others. The suture tape technique conferred the largest and most effective area of tendon coverage over the Hill-Sachs defect zone. Long-term success of the remplissage procedure can possibly be enhanced by increasing the interface area of tendon coverage over the Hill-Sachs defect. Clinical studies will be necessary to proof potential benefits for clinical outcome.
Collapse
Affiliation(s)
- Chung Hui James Tan
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - Tim Saier
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
- Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.
| | - Constantin von Deimling
- Department of Orthopaedics -Biomechanics Laboratory, Technische Universität München, Ismaninger Straße 22, Munich, 81675, Germany.
| | - Frank Martetschläger
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - Philipp Minzlaff
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
- Chirurgische Klinik Dr. Rinecker, Munich, Germany.
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
| | - Horazio Martinez
- Department of Orthopaedics -Biomechanics Laboratory, Technische Universität München, Ismaninger Straße 22, Munich, 81675, Germany.
| | - Sepp Braun
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technische Universität München, Munich, Germany.
| | - Rainer Burgkart
- Department of Orthopaedics -Biomechanics Laboratory, Technische Universität München, Ismaninger Straße 22, Munich, 81675, Germany.
| |
Collapse
|
29
|
Double-Barrel Remplissage: An Arthroscopic All-Intra-articular Technique Using the Double-Barrel Knot for Anterior Shoulder Instability. Arthrosc Tech 2015; 4:e65-70. [PMID: 25973376 PMCID: PMC4427641 DOI: 10.1016/j.eats.2014.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/06/2014] [Indexed: 02/03/2023] Open
Abstract
The arthroscopic remplissage procedure is an effective addition to a standard anterior repair in traumatic anterior shoulder instability associated with large humeral defects. The double-barrel remplissage is an all-intra-articular technique that uses a double-pulley, sliding, and self-retaining knot mechanism called the double-barrel knot. A 70° arthroscope (posterior portal) is necessary for adequate visualization of the humeral defect and the rotator cuff. Trans-tendon anchors (single or double loaded) are inserted into the superior and inferior aspects of the humeral defect through a cannula that is placed posterior to the infraspinatus. Placement of anchors is facilitated by insertion of a guidewire, as well as an anchor sleeve that is threaded over it. The double-barrel knot is formed using the anchors as a double-pulley system, and the knot is tensioned after the anterior repair is complete. Intra-articular visualization confirms adequate approximation and compression of the infraspinatus tendon and capsule into the defect. Advantages include an increased surface area (footprint) for healing and ease of knotting without the necessity for additional subacromial dissection.
Collapse
|