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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.
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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
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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.
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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
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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.
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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
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Wu YM, Xiao YF, Tang H, Xiong YL, Liu WJ, Meng JH, Gao SG. Anterior Shoulder Stabilization Using Single Needle-Assisted Outside-In Remplissage Technique and Bankart Repair. Arthrosc Tech 2024; 13:102904. [PMID: 38690354 PMCID: PMC11056644 DOI: 10.1016/j.eats.2023.102904] [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: 09/20/2023] [Accepted: 12/05/2023] [Indexed: 05/02/2024] Open
Abstract
Arthroscopic repair of Bankart injury is the first choice for the treatment of anterior shoulder instability. How to avoid recurring shoulder joint dislocation is a challenge, especially when combined with Hill-Sachs lesions. The arthroscopy technology allows for broader vision and less surgical trauma but is limited by a smaller operating space. At present, extensive descriptions about the surgical procedure of arthroscopic Bankart repair have been published. In this Technical Note, we describe the use of remplissage filling with Hill-Sachs lesion combined with Bankart repair to further improve the surgical accuracy and clinical efficacy. In particular, the application of single needle-assisted outside-in remplissage technique and Bankart repair is introduced in detail.
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Affiliation(s)
- Yu-Mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei-Jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jia-Hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Hachem AI, Molina-Creixell A, Rondanelli S. R, Valero-Cifuentes G, Campagnoli A, Hermida M, Rius X. Arthroscopic All-Inside Remplissage Technique With Knotless Tape Bridge for Hill-Sachs Lesions. Arthrosc Tech 2023; 12:e1487-e1494. [PMID: 37780647 PMCID: PMC10533679 DOI: 10.1016/j.eats.2023.04.021] [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: 02/11/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
The arthroscopic remplissage procedure has been described to successfully treat engaging Hill-Sachs lesions and improve shoulder stability. Several variations of this technique have been described, including remplissage with 1 or 2 knotted or knotless anchors, remplissage with double or triple bridging pulleys, and remplissage with or without a subacromial view. However, most techniques use anchors in combination with round sutures. This article describes an all-arthroscopic articular knotless remplissage technique using a strong, flat, double-strand suture tape bridge fixed with 2 small anchors under direct joint visualization and reduction of the capsule and infraspinatus without requiring a subacromial view.
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Affiliation(s)
- Abdul-ilah Hachem
- Department of Orthopedic Surgery, Bellvitge University Hospital (L’Hospitalet de Llobregat), Barcelona, Spain
| | | | | | | | | | - Miguel Hermida
- Hospital Clinico Santiago, Santiago de Compostela, Spain
| | - Xavier Rius
- Department of Orthopedic Surgery, Bellvitge University Hospital (L’Hospitalet de Llobregat), Barcelona, Spain
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Arthroscopic Hill-Sachs Filling Technique Using an Absorbable Interference Screw. Arthrosc Tech 2022; 11:e2389-e2395. [PMID: 36632382 PMCID: PMC9827193 DOI: 10.1016/j.eats.2022.08.046] [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: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
We present an arthroscopic technique used to treat traumatic shoulder instability in the patient with a Hill-Sachs lesion, especially an off-track lesion. The incidence of this bony defect is approximately 40% to 90% of all anterior shoulder instability cases-and up to 100% in patients with recurrent anterior instability. Incorrect management of this humeral bone defect can lead to treatment failure, and it is essential to define characteristics such as the lesion's location, depth, width, and orientation. Many arthroscopic and open procedures have been described for the surgical management of the Hill-Sachs lesion. Using arthroscopy for the surgical treatment of shoulder instability offers numerous advantages. We describe an arthroscopic technique that consists of filling the Hill-Sachs lesion with absorbable interference screws made out of an advanced biocomposite material. After repair of the Hill-Sachs lesion, the Bankart lesion is repaired. As these screws are resorbed by bone tissue over several months, the bony anatomy is restored.
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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.
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