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Ernstbrunner L, Werthel JD, Götschi T, Hooke AW, Zhao C. Anterolateral Acromioplasty Reduces Gliding Resistance Between the Supraspinatus Tendon and the Coracoacromial Arch in a Cadaveric Model. Arthrosc Sports Med Rehabil 2024; 6:100845. [PMID: 38226343 PMCID: PMC10788404 DOI: 10.1016/j.asmr.2023.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/07/2023] [Indexed: 01/17/2024] Open
Abstract
Purpose To investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy). Methods Using 4 fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III according to Bigliani). Subacromial bursa and coracoacromial ligament maintenance replicated physiologic sliding conditions. Gliding resistance was measured during glenohumeral abduction (0° to 60°) in internal rotation (IR) and external rotation (ER). Peak gliding resistance between the SSP tendon and the coracoacromial arch was determined and compared between intact, anterolateral acromioplasty, and acromionectomy. Results Peak SSP gliding resistance during abduction in an intact shoulder was significantly higher in IR than in ER (4.1 vs 2.1 N, P < .001). The mean peak SSP gliding resistance during 0° to 60° glenohumeral abduction in IR in the intact condition was significantly higher compared with the subacromial decompression condition (4.1 vs 2.8 N, P = .021) and with the acromionectomy condition (4.1 vs 0.9 N, P < .001). During 0° to 60° glenohumeral abduction in ER, mean peak SSP gliding resistance in the intact condition was not significantly different compared with the subacromial decompression condition (2.1 vs 2.0 N, P = .999). The 2 specimens with a hooked (i.e. type III) acromion showed significantly higher mean peak SSP gliding resistance during glenohumeral abduction in IR and ER when compared with the 2 specimens with a flat (i.e. type I) acromion (IR: 5.8 vs 3.0 N, P = .006; ER: 2.8 vs 1.4 N, P = .001). Conclusions In this cadaveric study, peak gliding resistance between the SSP tendon and the coracoacromial arch during combined abduction and IR was significantly reduced after anterolateral acromioplasty and was significantly higher in specimens with a hooked acromion. Clinical Relevance The clinical benefit of subacromial decompression remains unclear. This study suggests that anterolateral acromioplasty might reduce supraspinatus gliding resistance in those with a hooked acromion and in the typical "impingement" position.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jean-David Werthel
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Tobias Götschi
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Alex W. Hooke
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chunfeng Zhao
- Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota, U.S.A
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Horinek JL, Menendez ME, Narbona P, Lädermann A, Barth J, Denard PJ. Arthroscopic Bankart Repair With Remplissage as an Alternative to Latarjet for Anterior Glenohumeral Instability With More Than 15% Glenoid Bone Loss. Orthop J Sports Med 2022; 10:23259671221142257. [PMID: 36532154 PMCID: PMC9756371 DOI: 10.1177/23259671221142257] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Surgical management of anterior shoulder instability continues to evolve. The clinical effectiveness of arthroscopic Bankart repair with remplissage (REMP) in patients with increasing glenoid bone loss (GBL) has not been thoroughly compared with Latarjet. PURPOSE/HYPOTHESIS The purpose of this study was to compare 2-year outcomes of REMP versus open Latarjet in patients with >15% GBL. We hypothesized that there would be no difference. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter, retrospective study was performed on a consecutive series of patients who underwent primary REMP or Latarjet by 4 shoulder specialists between August 2013 and December 2019 for >15% GBL. Procedure performance was based on shared decision making between the surgeon and patient. Baseline and 2-year postoperative range of motion (ROM) and the following patient-reported outcomes (PROs) were collected: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Return to sport, satisfaction, complications, recurrence, and revisions were reviewed. RESULTS A total of 47 patients were available for study, including 22 who underwent REMP and 25 who underwent Latarjet. Baseline demographic characteristics, ROM, and PROs were similar between the groups. Mean preoperative GBL (REMP 25.8% ± 7.8% vs Latarjet 25.1% ± 9.0%; P = .800) and off-track lesions (REMP 59.1% vs Latarjet 44.0%; P = .302) were similar. Postoperative change in external rotation favored Latarjet (10° ± 22° vs -4° ± 13°; P = .017). Postoperative PROs, return to the sports (86.4% vs 87.5%; P = .99), and satisfaction (95.5% vs 95.8%; P = .99) were similar between groups. There were no recurrent dislocations in either group. One infected hematoma was encountered in the Latarjet cohort. CONCLUSION At short-term follow-up, the hypothesis was upheld. REMP and Latarjet provided similar outcomes for patients with >15% GBL, although REMP patients experienced slightly decreased external rotation. Although larger series and longer-term follow-ups are required, remplissage may be considered in patients with >15% glenoid bone loss.
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Affiliation(s)
| | | | - Pablo Narbona
- Department of Shoulder Surgery and Arthroscopy, Sanatorio Allende, Cardoba, Argentina
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Johannes Barth
- Department of Orthopedic Surgery, Clinique des Cedres, Echirolles, France
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Horinek JL, Menendez ME, Narbona P, Lädermann A, Barth J, Denard PJ. Remplissage Yields Similar 2-Year Outcomes, Fewer Complications, and Low Recurrence Compared to Latarjet Across a Wide Range of Preoperative Glenoid Bone Loss. Arthroscopy 2022; 38:2798-2805. [PMID: 35405284 DOI: 10.1016/j.arthro.2022.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare functional outcome, return to sport, satisfaction, postoperative recurrence, and complications in patients undergoing primary arthroscopic Bankart repair with remplissage (ABR) to primary Latarjet. METHODS A multicenter retrospective study was performed on patients undergoing primary ABR or open Latarjet between 2013 and 2019 who had a minimum 2-year follow-up. Baseline and two-year range of motion (ROM), patient-reported outcomes (PROs: Western Ontario Shoulder Instability Index [WOSI], Single Assessment Numeric Evaluation [SANE], and visual analog scale [VAS] for pain) recurrence, return to sport, satisfaction, and complications were reviewed. RESULTS This study included 258 patients, including 70 ABRs and 188 Latarjet procedures. Baseline demographics, ROM, and PROs were similar. Mean preop glenoid bone loss (GBL) (12.3% ± 10.9% vs 7.6% ± 9%; P < .001) and off-track lesions (23% vs 13%; P = .046) were higher in the ABR group, while preoperative GBL range was similar (0-42% vs 0-47%). Changes in the VAS (1.9 vs 0.9; P = .019) and WOSI (1096 vs 805; P < .001) were improved in ABR. The percentage of patients who achieved a minimal clinically important difference was improved in WOSI for ABR and PASS for ABR in SANE, VAS, and WOSI scores. The ABR cohort reported worse changes in external rotation (ER) (-4° vs +19°; P < .001). Return to sport among overhead and contact athletes favored ABR (91.5% vs 72.7%; P = .007). Satisfaction and recurrent dislocation were similar. Surgical complications were observed in 0% of ABR cases, compared to 5.9% in the Latarjet group. CONCLUSION Primary ABR resulted in 2-year functional outcomes that were as good or superior to primary Latarjet, with higher return to sport for overhead and contact activities, fewer complications, and comparably low recurrence rates, even despite greater bipolar bone loss in the ABR cohort. However, this comes at the expense of decreased external rotation, which may be considered in individual patients. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
| | - Mariano E Menendez
- Department of Shoulder and Elbow Surgery, Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A
| | - Pablo Narbona
- Department of Shoulder Surgery and Arthroscopy, Sanatorio Allende, Cardoba, Argentina
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Johannes Barth
- Department of Orthopaedic Surgery, Clinique des Cèdres, Echirolles, France
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Abstract
Background Arthroscopic Bankart repair with Hill-Sachs remplissage (BHSR) is suggested for the treatment of anterior shoulder instability in the presence of an engaging humeral lesion. The objective of this study is to report the long-term clinical and radiological results of this procedure. Methods This is a single-center retrospective study including 51 patients who underwent surgery by BHSR for anterior shoulder instability with engaging Hill-Sachs lesion and who were reviewed after a minimum follow-up of 5 years. The mean age was 26 years (16-49; ±8.4) and 70% of the patients practiced sports. The average for Instability Severity Index score was 3.3 points (3-7; ±1.7). At the last follow-up, active range of motion, Subjective Shoulder Value, Walch-Duplay and Rowe scores, and the incidence of osteoarthritis according to the Samilson classification were assessed. Results At a mean follow-up of 87 months (60.0-124; ±17), 83% of the patients had resumed their sports activities. The mean Rowe, Walch-Duplay, and Subjective Shoulder Value scores were respectively 88 points (51-100; ±12), 82 points (50-100; ±16.4), and 89% (50-100; ±8). There was a recurrence of dislocation or subluxation for 8 patients (15.6%). In univariate analysis, patients who were unstable at follow-up had a deeper Hill-Sachs lesion (25% vs. 18% of the humeral head radius, P = .04) and were younger (19 vs. 27 years, P = .04). Radiographically, 17% of the patients showed signs of osteoarthritis (14% grade 1). Conclusion Considering that at a follow-up of more than 5 years, the failure rate was more than 15% of the BHSR, this procedure should be recommended with caution in case of deep Hill-Sachs lesions in young patients. The incidence of osteoarthritis after this procedure was acceptable, with few severe forms.
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Randelli PS, Compagnoni R, Radaelli S, Gallazzi MB, Tassi A, Menon A. Arthroscopic remplissage is safe and effective: clinical and magnetic resonance results at a minimum 3 years of follow-up. J Orthop Traumatol 2022; 23:5. [PMID: 34997890 PMCID: PMC8742794 DOI: 10.1186/s10195-021-00624-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Large Hill-Sachs lesions are considered a risk factor for recurrence of instability after arthroscopic Bankart repair alone. The aim of this study was to demonstrate that remplissage is a safe procedure that effectively reduces the risk of recurrent dislocations without causing fatty degeneration of the infraspinatus at medium-term follow-up. METHODS Patients who underwent arthroscopic Bankart repair and remplissage with a minimum 3 years of follow-up were included. Constant-Murley (CMS), American Shoulder and Elbow Surgeons (ASES), and Walch-Duplay scores were evaluated. Magnetic resonance imaging (MRI) was performed to detect the appearance of fatty infiltration inside the infraspinatus muscle, the percentage of the Hill-Sachs lesion filled by the tendon and its integration, and the onset of rotator cuff tears. RESULTS Thirteen patients (14 shoulders) with a mean follow-up of 55.93 (± 18.16) months were enrolled. The Walch-Duplay score was 95.00 [87.25-100.00], with a return to sport rate of 100%. Both the CMS and the ASES indicated excellent results. The affected shoulders showed a statistically significant reduction in active external rotation both with the arm at the side (ER1) and with the arm at 90° of abduction (ER2) (p = 0.0005 and p = 0.0010, respectively). A reduction in infraspinatus isometric strength was found for both ER1 and ER2, but this reduction was only statistically relevant in ER2 (p = 0.0342). There was a traumatic recurrence of instability in two cases (14.28%). MRI evaluation demonstrated an absence of adipose infiltration in 50% of cases and only a minimal amount in the remaining 50%. In 12 cases (85.72%), the capsulotenodesis completely filled the lesion and good tendon-bone integration was observed. CONCLUSION Arthroscopic remplissage provided successful clinical outcomes without fatty infiltration of the infraspinatus and with good healing of the tissues. The low risk of recurrence was associated with an objective limitation on active external rotation, but this did not influence the patients' daily or sports activities. LEVEL OF EVIDENCE Cohort study, level of evidence 3.
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Affiliation(s)
- Pietro S. Randelli
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli studi di Milano, Via della Commenda 10, 20122 Milan, Italy
| | - Simone Radaelli
- U.O.C. Week Surgery Di Ortopedia E Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Mauro B. Gallazzi
- U.O.C. Radiodiagnostica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alberto Tassi
- U.O.C. Week Surgery Di Ortopedia E Traumatologia, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. 1a Clinica Ortopedica, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Shah SS, Kontaxis A, Jahandar A, Bachner E, Gulotta LV, Dines DM, Warren RF, Dines JS, Taylor SA. Superior capsule reconstruction using a single 6-mm-thick acellular dermal allograft for massive rotator cuff tears: a biomechanical cadaveric comparison to fascia lata allograft. J Shoulder Elbow Surg 2021; 30:2166-2176. [PMID: 33418091 DOI: 10.1016/j.jse.2020.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Success of superior capsule reconstruction (SCR) using both fascia lata (FL) and human acellular dermal (ACD) allografts have been reported. One possible explanation for a discrepancy in outcomes may be attributed to graft thickness. SCR with commercially available 3-mm-thick ACD allograft is not biomechanically equivalent to FL. Our hypothesis was that SCR with a single 6-mm-thick ACD allograft will restore the subacromial space distance (SubDist) and peak subacromial contact pressures (PSCPs) to intact shoulder and will be comparable to SCR with an 8-mm FL allograft. METHODS Eight cadaveric shoulders were tested in 4 conditions: intact, irreparable supraspinatus tear (SST), SCR FL allograft (8-mm-thick), and SCR single ACD allograft (6-mm-thick). SubDist and PSCP were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Parameters were compared using a repeated measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t test. RESULTS SST had decreased SubDist (P < .05) and increased PSCP (P < .05) compared with the intact state. At all angles, the SCR ACD allograft demonstrated increased SubDist compared with the tear condition (P < .001), with no difference between grafts. Furthermore, there was decreased PSCP after both ACD and FL SCR compared with the intact condition, with no difference between grafts at 0° (P = .006, P = .028) and 60° abduction (P = .026, P = .013). Both ACD and FL grafts elongated during testing. CONCLUSIONS Our results suggest SCR with a single 6-mm-thick ACD allograft is noninferior to FL regarding SubDist and PSCP while completely restoring the superior stability of the glenohumeral joint compared with the intact state.
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Affiliation(s)
| | | | | | - Emily Bachner
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Callegari JJ, Phillips CJ, Denard PJ. All-Inside Knotless Remplissage Technique. Arthrosc Tech 2021; 10:e1479-e1484. [PMID: 34258193 PMCID: PMC8252846 DOI: 10.1016/j.eats.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/08/2021] [Indexed: 02/03/2023] Open
Abstract
Remplissage decreases the risk of recurrence after arthroscopic stabilization for recurrent anterior instability. Traditionally, the procedure requires accessing the subacromial space, which adds time and morbidity to the procedure. This Technical Note describes an all-inside technique for knotless remplissage with 2 interconnected anchors. By avoiding knot tying or accessing the subacromial space, the efficiency of the procedure is improved.
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Affiliation(s)
| | | | - Patrick J. Denard
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, U.S.A
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Haroun HK, Sobhy MH, Abdelrahman AA. Arthroscopic Bankart repair with remplissage versus Latarjet procedure for management of engaging Hill-Sachs lesions with subcritical glenoid bone loss in traumatic anterior shoulder instability: a systematic review and meta-analysis. J Shoulder Elbow Surg 2020; 29:2163-2174. [PMID: 32807370 DOI: 10.1016/j.jse.2020.04.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A large engaging Hill-Sachs lesion (HSL) with subcritical glenoid bone loss (GBL) is approached through either increasing the glenoid arc by the Latarjet procedure or converting the HSL to an extra-articular defect by arthroscopic Bankart repair with remplissage (BRR). Until now, there has been no evidence-based consensus about which of these 2 most appropriate procedures is the better surgical choice. The purpose of this study was to analyze the current literature comparing results of BRR vs. the Latarjet procedure in the treatment of engaging HSLs with subcritical GBL. METHODS A comprehensive review of the PubMed and Cochrane databases was completed for studies that compared the clinical outcomes and complications of BRR vs. the Latarjet procedure with minimum follow-up of 2 years. The outcome measures analyzed included postoperative Rowe score, visual analog scale pain score, postoperative range of motion (ROM), and rates of recurrent instability and other complications. RESULTS Overall, 4 articles (level III evidence in 3 and level II in 1) were included from an initial 804 abstracts. The study population consisted of a total of 379 patients, of whom 194 underwent BRR and 185 underwent the Latarjet procedure. There were no unacceptable differences in baseline characteristics between the 2 groups. For the rate of recurrent instability, both groups had comparable risk ratios (RRs) (N = 379; RR, 0.72; 95% confidence interval [CI], 0.37-1.41). The risk of other complications was significantly increased with the Latarjet procedure (by about 7 times) relative to the the BRR procedure (N = 379; RR, 7.37; 95% CI, 2-27). Both groups had comparable postoperative Rowe scores (n = 190; mean difference [MD], -0.9; 95% CI, -3.45 to 1.7) and visual analog scale pain scores (n = 347; MD, -0.2; 95% CI, -0.6 to 0.2). Moreover, both groups had comparable postoperative external rotation ROM (MD, -1.7°; 95% CI, -9.4° to 6°) and internal rotation ROM (MD, 1.95°; 95% CI, -5.35° to 9.25°). There was substantial heterogeneity in the effect of both procedures on postoperative pain and ROM (external rotation and internal rotation). CONCLUSION Both the BRR and Latarjet procedures are effective for the management of engaging HSLs with subcritical GBL and give comparable clinical outcomes. However, given the fewer overall postoperative complications, remplissage may be safer. The results of the included studies were adequately consistent for most analyzed outcomes. However, for the intervention effect on postoperative pain and ROM, there was a small body of evidence, limiting the strength of the reported conclusions.
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Affiliation(s)
- Haitham K Haroun
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Mohamed H Sobhy
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr A Abdelrahman
- Orthopedic Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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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.
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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
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Hatta T, Yamamoto N, Shinagawa K, Kawakami J, Itoi E. Surgical decision making based on the on-track/off-track concept for anterior shoulder instability: a case-control study. JSES OPEN ACCESS 2019; 3:25-28. [PMID: 30976732 PMCID: PMC6443644 DOI: 10.1016/j.jses.2018.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study was to assess the clinical outcomes of patients with anterior shoulder instability who underwent surgical treatment according to the on-track/off-track concept. Methods We retrospectively analyzed patients who underwent surgical treatment according to the glenoid track concept with a minimum of 2 years’ follow-up. By use of preoperative 3-dimensional computed tomography images, surgical options were selected: arthroscopic Bankart repair (ABR) for patients with on-track lesions and the Latarjet procedure or ABR with the remplissage procedure for patients with off-track lesions. The recurrence rate was assessed at 2-year follow-up after surgery. Results Among 92 patients enrolled in this study, 81 had on-track lesions and underwent ABR. Of the 11 patients with off-track lesions, 1 underwent ABR with the remplissage procedure and 10 underwent the Latarjet procedure. Recurrences occurred in 4 patients treated by ABR (5%), whereas no recurrences were observed in off-track cases treated by the remplissage or Latarjet procedure. Conclusion Clinical application of the on-track/off-track concept for determining surgical options in preoperative planning seems to be useful to prevent recurrent instability after surgery.
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Affiliation(s)
- Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Momma D, Nimura A, Muro S, Fujishiro H, Miyamoto T, Funakoshi T, Mochizuki T, Iwasaki N, Akita K. Anatomic analysis of the whole articular capsule of the shoulder joint, with reference to the capsular attachment and thickness. J Exp Orthop 2018; 5:16. [PMID: 29881921 PMCID: PMC5992113 DOI: 10.1186/s40634-018-0134-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/29/2018] [Indexed: 01/14/2023] Open
Abstract
Background Although conventional Bankart repair has been the accepted procedure for traumatic anterior glenohumeral instability, the humeral avulsion of the glenohumeral ligament or an elongation of the capsule remains challenging to decide the appropriate treatment. The anatomical knowledge regarding the whole capsule of glenohumeral joint is necessary to accurately treat for the capsular disorders. The aims of the current study were to investigate the anatomical features of capsular attachment and thickness in a whole capsule of glenohumeral joint. Methods We used 13 shoulders in the current study. In 9 shoulders, we macroscopically measured the attachment widths of the capsulolabrum complex on the scapular glenoid, and the attachment widths of the capsule on the humerus in reference to the scapular origin of the long head of triceps brachii, and the humeral insertion of the rotator cuff tendons. We additionally used 4 cadaveric shoulders, which were embalmed using Thiel’s method, for the analysis of the thickness in a whole capsule by using micro-CT. Results The glenoidal attachment of the articular capsule appeared to have a consistent width except for the superior part of the origin of the long head of triceps brachii. On the humerus, the articular capsule was widely attached to areas without overlying rotator cuffs, with the widest width (17.3 ± 0.9 mm) attached to the axillary pouch. The inferior part of the capsule, which was consistently thicker than the superior part, continued to the superior part along the glenoid and humeral side edge. Conclusions The current study showed that the inferior part of the glenohumeral capsule had a wide humeral attachment from the inferior edge of the subscapularis insertion to the inferior edge of the teres minor insertion via the anatomical neck of the humerus, and the thickness of it was thicker than the superior part of the capsule.
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Affiliation(s)
- Daisuke Momma
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Satoru Muro
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitomi Fujishiro
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Miyamoto
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadanao Funakoshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
Posterolateral humeral head defects can be large and engage on the anterior glenoid, and they usually contribute to anterior shoulder instability in 40% to 90% of cases. The purpose of this study is to evaluate the results of the largest series of patients who underwent arthroscopic remplissage with Bankart repair for recurrent anterior shoulder instability due to associated Bankart lesions, with large and engaging (> 25% involvement) humeral Hill-Sachs defects (HSDs). A total of 51 patients underwent arthroscopic Bankart repair with remplissage technique for the treatment of recurrent anterior glenohumeral instability with large and medial HSDs. Pre-operative imaging in all patients identified a Bankart lesion with an associated HSD that involved > 25% of the humeral head. The Rowe score was used to assess the patients clinically. A total of 46 patients were male. The mean age of the patients was 28.7 years (18 to 43). The mean follow-up period was 31 months (20 to 39). At the final follow-up, three patients reported recurrence of instability (two dislocations and one subluxation). The mean Rowe score improved to 95.4 points (function, 45.5 of 50; stability, 26.4 of 30; motion, 8 of 10; pain, 8 of 10). The arthroscopic remplissage technique with Bankart repair gave satisfactory results and is still considered to be an effective, safe and reliable procedure for treatment of glenohumeral instability in cases with large and medial HSDs.
Cite this article: EFORT Open Rev 2017;2:478–483. DOI: 10.1302/2058-5241.2.160070
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Affiliation(s)
- Mohamed G Morsy
- El-Hadara Orthopaedic and Traumatology Hospital, Alexandria University, Egypt
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13
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Tang J, Xu C, Zhao J. Arthroscopic Bone Grafting of the Humeral Head for Treatment of a Deep Hill-Sachs Lesion. Arthrosc Tech 2017; 6:e1653-e1659. [PMID: 29399448 PMCID: PMC5794908 DOI: 10.1016/j.eats.2017.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023] Open
Abstract
Recurrent anterior shoulder dislocation often leads to the presence of a Hill-Sachs lesion. A large Hill-Sachs lesion compromises shoulder stability and should be addressed with bone augmentation when it is too deep. Here, we introduce a method of arthroscopic bone grafting of the humeral head for the treatment of a deep Hill-Sachs lesion in patients with anterior shoulder instability. Our indication for this procedure is a deep off-track Hill-Sachs lesion measuring at least 8 mm in depth and 10 mm in width. The main steps of this procedure include graft placement via special shoulder bone grafting instruments, graft suspension fixation using suture anchors, and bone fragment compression using the infraspinatus tendon. We routinely use this technique in combined treatment procedures for complicated anterior shoulder instability.
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Affiliation(s)
- Jin Tang
- Operating Theatre, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.Department of Sports MedicineShanghai Sixth People's HospitalShanghai Jiao Tong University600 Yishan RoadShanghai200233China
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Kahlenberg CA, Garcia GH, Degen RM, Liu JN, Dines JS. The Intra-articular "Wave Sign" as a Landmark for Suture Anchor Placement in Arthroscopic Remplissage. Orthopedics 2017; 40:e831-e835. [PMID: 28662251 DOI: 10.3928/01477447-20170619-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/08/2017] [Indexed: 02/03/2023]
Abstract
In arthroscopic remplissage, surgeons may inadvertently pass sutures through the teres minor rather than the infraspinatus tendon. This misplacement of the sutures may lead to poor outcomes. The authors describe the novel use of the posterior band of the inferior glenohumeral ligament, known as the "wave sign," as a reliable intra-articular landmark for suture anchor placement to improve suture passage accuracy. Twelve cadaveric shoulders underwent arthroscopic remplissage by a fellowship-trained surgeon. During the first phase of the study, remplissage was performed on 6 specimens with standard technique. The intra-articular wave sign was visualized on all specimens. Specimens were dissected to the level of the joint, and the location of each suture anchor and suture pass was noted. Using the results from the first set of specimens, the surgeon performed remplissage in the second set of 6 specimens using specific measurements from intra-articular landmarks. On dissection of the initial 6 specimens, 75% of sutures were passed through the infraspinatus and 25% were passed through the teres minor. For the remaining 6 specimens, care was taken to place 1 suture anchor at the superior edge of the wave sign and 1 suture anchor 1 cm superior to the wave sign. When suture anchors were successfully passed above the superior tip of the wave sign, the likelihood of infraspinatus tendon penetration was 17 times greater. Placement of the suture anchors at or above the superior tip of the intra-articular wave sign most reliably produced capsulotenodesis of the infraspinatus muscle. [Orthopedics. 2017; 40(5):e831-e835.].
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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.
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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
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Garcia GH, Degen RM, Liu JN, Kahlenberg CA, Hurwit DJ, Dines JS. The "Safe Zone" Technique Improves Suture Placement and Accuracy During Arthroscopic Remplissage. Orthopedics 2017; 40:e598-e603. [PMID: 28418576 DOI: 10.3928/01477447-20170411-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
In response to recent concerns about the accuracy of suture passage during arthroscopic remplissage, this study was conducted to determine whether a previously described "safe zone" technique can improve the accuracy of suture passage. A recommended safe zone technique was used for arthroscopic remplissage on 6 cadaveric specimens. The safe zone was described as a region at least 1 cm lateral and no greater than 3 cm distal to the posterolateral acromion. Results were compared with a control group of 6 specimens for which the safe zone technique was not used. For each group, 24 suture passes were performed. In the safe zone group, 83.3% (20 of 24) of sutures passed through the infraspinatus tendon. This was a significant improvement compared with the control group, in which only 25% (6 of 24) of sutures pierced the infraspinatus tendon (P<.01). In the safe zone group, 4.2% (1 of 24) of attempted suture passes were placed through the muscle or musculotendinous junction compared with 75% (18 of 24) in the control group (P<.01). Prevention of overmedialization improved significantly with the safe zone technique. In the safe zone group, both anchors had significantly more lateral (6 to 10 mm) suture passage compared with the control group (P<.01). The safe zone technique also showed greater precision of suture passes, and overall precision (SD) improved in 75% of passes. The safe zone technique significantly improved the accuracy of suture penetration into the infraspinatus tendon during arthroscopic remplissage. This reproducible method may help to prevent the reported complications of remplissage. [Orthopedics. 2017; 40(4):e598-e603.].
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Biomechanical comparison of acute Hill-Sachs reduction with remplissage to treat complex anterior instability. J Shoulder Elbow Surg 2017; 26:1088-1096. [PMID: 28131690 DOI: 10.1016/j.jse.2016.11.050] [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] [Received: 08/24/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute Hill-Sachs reduction represents a potential alternative method to remplissage for the treatment of an engaging Hill-Sachs lesion. This study biomechanically compared the stabilizing effects of an acute Hill-Sachs reduction technique and remplissage. METHODS Six cadaveric shoulders were tested. For the acute Hill-Sachs lesion, a unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface. Five scenarios were tested: intact specimen, bipolar lesion, Bankart repair, remplissage with Bankart repair, and Hill-Sachs reduction technique with Bankart repair. The Hill-Sachs lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with bone cement. RESULTS At 90° of abduction and external rotation (ER), total translation was 11.6 ± 0.9 mm for the bipolar lesion. This was significantly reduced after remplissage (5.9 ± 1.1 mm; P < .001) and after Hill-Sachs reduction (4.7 ± 0.4 mm; P < .001). Compared with an isolated Bankart repair, the average ER loss after remplissage was 4° ± 4° (P = .65), and the average ER loss after Hill-Sachs reduction was 1° ± 3° (P = .99). Similar joint stability was conferred after both procedures, with minimal change in range of motion. CONCLUSIONS Remplissage may still be the best way to address chronic Hill-Sachs lesions; however, the reduction technique is a more anatomic alternative and may be a potential option for treating an acutely engaging Hill-Sachs lesion.
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18
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Walley KC, Haghpanah B, Hingsammer A, Harlow ER, Vaziri A, DeAngelis JP, Nazarian A, Ramappa AJ. Influence of disruption of the acromioclavicular and coracoclavicular ligaments on glenohumeral motion: a kinematic evaluation. BMC Musculoskelet Disord 2016; 17:480. [PMID: 27855670 PMCID: PMC5112880 DOI: 10.1186/s12891-016-1330-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Changes to the integrity of the acromioclavicular (AC) joint impact scapulothoracic and clavicular kinematics. AC ligaments provide anterior-posterior stability, while the coracoclavicular (CC) ligaments provide superior-inferior stability and a restraint to scapular internal rotation. The purpose of this cadaveric study was to describe the effect of sequential AC and CC sectioning on glenohumeral (GH) kinematics during abduction (ABD) of the arm. We hypothesized that complete AC ligament insult would result in altered GH translation in the anterior-posterior plane during abduction, while subsequent sectioning of both CC ligaments would result in an increasing inferior shift in GH translation. Methods Six cadaveric shoulders were studied to evaluate the impact of sequential sectioning of AC and CC ligaments on GH kinematics throughout an abduction motion in the coronal plane. Following an examination of the baseline, uninjured kinematics, the AC ligaments were then sectioned sequentially: (1) Anterior, (2) Inferior, (3) Posterior, and (4) Superior. Continued sectioning of CC ligamentous structures followed: the (5) trapezoid and then the (6) conoid ligaments. For each group, the GH translation and the area under the curve (AUC) were measured during abduction using an intact cadaveric shoulder. Total translation was calculated for each condition between ABD 30° and ABD 150° using the distance formula, and a univariate analysis was used to compare total translation for each axis during the different conditions. Results GH kinematics were not altered following sequential resection of the AC ligaments. Disruption of the trapezoid resulted in significant anterior and lateral displacement of the center of GH rotation. Sectioning the conoid ligament further increased the inferior shift in GH displacement. Conclusion A combined injury of the AC and CC ligaments significantly alters GH kinematics during abduction. Type III AC separations, result in a significant change in the shoulder’s motion and may warrant surgical reconstruction to restore normal function.
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Affiliation(s)
- Kempland C Walley
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Babak Haghpanah
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Andreas Hingsammer
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA.
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Sheean AJ, De Beer JF, Di Giacomo G, Itoi E, Burkhart SS. Shoulder instability: State of the Art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Garcia GH, Degen RM, Liu JN, Kahlenberg CA, Dines JS. Accuracy of Suture Passage During Arthroscopic Remplissage-What Anatomic Landmarks Can Improve It?: A Cadaveric Study. Orthop J Sports Med 2016; 4:2325967116663497. [PMID: 27606326 PMCID: PMC4997326 DOI: 10.1177/2325967116663497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Recent data suggest that inaccurate suture passage during remplissage may contribute to a loss of external rotation, with the potential to cause posterior shoulder pain because of the proximity to the musculotendinous junction. Purpose: To evaluate the accuracy of suture passage during remplissage and identify surface landmarks to improve accuracy. Study Design: Descriptive laboratory study. Methods: Arthroscopic remplissage was performed on 6 cadaveric shoulder specimens. Two single-loaded suture anchors were used for each remplissage. After suture passage, position was recorded in reference to the posterolateral acromion (PLA), with entry perpendicular to the humeral surface. After these measurements, the location of posterior cuff penetration was identified by careful surgical dissection. Results: Twenty-four sutures were passed in 6 specimens: 6 sutures (25.0%) were correctly passed through the infraspinatus tendon, 12 (50%) were through the infraspinatus muscle or musculotendinous junction (MTJ), and 6 (25%) were through the teres minor. Suture passage through the infraspinatus were on average 25 ± 5.4 mm inferior to the PLA, while sutures passing through the teres minor were on average 35.8 ± 5.7 mm inferior to the PLA. There was an odds ratio of 25 (95% CI, 2.1-298.3; P < .001) that the suture would be through the infraspinatus if the passes were less than 3 cm inferior to the PLA. Sutures passing through muscle and the MTJ were significantly more medial than those passing through tendon, measuring on average 8.1 ± 5.1 mm lateral to the PLA compared with 14.5 ± 5.5 mm (P < .02). If suture passes were greater than 1 cm lateral to the PLA, it was significantly more likely to be in tendon (P = .013). Conclusion: We found remplissage suture passage was inaccurate, with only 25% of sutures penetrating the infraspinatus tendon. Passing sutures 1 cm lateral and within 3 cm inferior of the PLA improves the odds of successful infraspinatus tenodesis. We recommend this “safe zone” to improve the odds of infraspinatus tenodesis during remplissage. These results may help improve remplissage techniques and prevent previously reported complications, including external rotation loss and pain from myodesis.
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Affiliation(s)
| | - Ryan M Degen
- Hospital for Special Surgery, New York, New York, USA
| | - Joseph N Liu
- Hospital for Special Surgery, New York, New York, USA
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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]
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22
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Garcia GH, Wu HH, Liu JN, Huffman GR, Kelly JD. Outcomes of the Remplissage Procedure and Its Effects on Return to Sports: Average 5-Year Follow-up. Am J Sports Med 2016; 44:1124-30. [PMID: 26888881 DOI: 10.1177/0363546515626199] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short-term outcomes for patients with large, engaging Hill-Sachs lesions who underwent remplissage have demonstrated good results. However, limited data are available for longer term outcomes. PURPOSE To evaluate the long-term outcomes of remplissage and determine the long-term rate of return to specific sports postoperatively. STUDY DESIGN Case series; Level of evidence, 4. METHODS This was a retrospective review of patients treated with the remplissage procedure from 2007 to 2013. All underwent preoperative magnetic resonance imaging demonstrating large Hill-Sachs lesions by the Rowe criteria and glenoid bone loss <20%. All Hill-Sachs lesions were "off track" by an arthroscopic examination and preoperative imaging. At final follow-up, patients underwent a range of motion evaluation and were administered a detailed outcome survey, which included Western Ontario Shoulder Instability Index (WOSI) and American Shoulder and Elbow Surgeons (ASES) scores as well as questions regarding sports, employment, physical activities, and dislocation events. RESULTS A total of 50 patients (51 shoulders) were included in the study. The average patient age at surgery was 29.8 years (range, 15.0-72.4 years), and the average follow-up time was 60.7 months (range, 25.5-97.6 months); 20.0% of patients underwent previous surgery on their shoulder. The average postoperative WOSI score was 79.5%, and the average ASES score was 89.3. Six shoulders had dislocation events (11.8%) postoperatively: 3 were traumatic, and 3 were atraumatic. Increased preoperative dislocations led to a greater risk of a postoperative dislocation (P < .001). There was also a trend toward higher postoperative dislocation rates in patients who underwent revision (P = .062). The average loss of external rotation was 5.26° (P = .13). The rate of return to ≥1 sports was 95.5% of patients at an average of 7.0 months postoperatively; 81.0% returned to their previous intensity and level of sport. Of patients who played a throwing sport, 65.5% (n = 19) stated that they had problems throwing, and 58.6% (n = 17) felt that they could not normally wind up throwing a ball. Direct rates of return to overhead sports were volleyball, 100%; basketball, 69%; baseball, 50%; and football, 50%. CONCLUSION The redislocation rate after remplissage was 11.8% at an average of 5 years, with 95.5% of patients returning to full sports at an average of 7 months. For throwing sports, 65.5% of patients complained of decreased range of motion during throwing. The results should be considered preoperatively in candidates for remplissage who are engaged in throwing sports.
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Affiliation(s)
| | - Hao-Hua Wu
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph N Liu
- Hospital for Special Surgery, New York, New York, USA
| | - G Russell Huffman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John D Kelly
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Matsen FA, Lauder A, Rector K, Keeling P, Cherones AL. Measurement of active shoulder motion using the Kinect, a commercially available infrared position detection system. J Shoulder Elbow Surg 2016; 25:216-23. [PMID: 26341024 DOI: 10.1016/j.jse.2015.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The shoulder's ability to participate in sports and activities of daily living depends on its active range of motion. Clinical goniometry is of limited utility in rigorously assessing limitation of motion and the effectiveness of treatment. We sought to determine (1) whether a validated position-sensing tool, the Kinect, can enable the objective clinical measurement of shoulder motion and (2) the degree to which active range of motion correlates with patient self-assessed shoulder function. METHODS In 10 control subjects, we compared Kinect motion measurements to measurements made on standardized anteroposterior and lateral photographs taken concurrently. In 51 patients, we correlated active motion with the ability to perform the functions of the Simple Shoulder Test (SST). RESULTS In controls, Kinect measurements strongly agreed with photographic measurements. In patients, the total SST score was strongly correlated with the range of active abduction. The ability to perform each of the individual SST functions was strongly correlated with active motion. The active motion in well-functioning patient shoulders averaged 155° ± 22° abduction, 159° ± 14° flexion, 76° ± 18° external rotation in abduction, -59° ± 25° internal rotation in abduction, and -3.3 ± 3.7 inches of cross-body adduction, values similar to the control shoulders. Use of the Kinect system was practical in clinical examination rooms, requiring <5 minutes to document the 5 motions in both shoulders. DISCUSSION The Kinect provides a clinically practical method for objectively measuring active shoulder motion. Active motion was an important determinant of patient-assessed shoulder function.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Alexander Lauder
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Kyle Rector
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Peyton Keeling
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Arien L Cherones
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Garcia GH, Liu JN, Dines DM, Dines JS. Effect of bone loss in anterior shoulder instability. World J Orthop 2015; 6:421-433. [PMID: 26085984 PMCID: PMC4458493 DOI: 10.5312/wjo.v6.i5.421] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/20/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability.
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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.
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Petterson SC, Plancher KD. The Surgeons’ Dilemma: Revision Instability in the Athlete. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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