Pulatkan A, Kapicioglu M, Ucan V, Masai MN, Ozdemir B, Akpinar S, Bilsel K. Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?
Orthop J Sports Med 2021;
9:23259671211008152. [PMID:
34262976 PMCID:
PMC8243109 DOI:
10.1177/23259671211008152]
[Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background:
Different techniques are used for the remplissage procedure, including the
double-pulley and mattress suture techniques. Both techniques have shown
good results; however, it is unclear if one technique is superior.
Hypothesis:
The remplissage procedure using the double-pulley technique with 2 anchors
would have superior functional and radiological outcomes compared with the
mattress suture technique with a single anchor.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
This study included patients with anterior shoulder instability who were
treated using arthroscopic Bankart repair combined with remplissage between
2012 and 2017. A structured questionnaire was used to gather information on
the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya
index, presence of a Hill-Sachs defect, number of dislocations before
surgery, sports participation, radiological measurement of the Hill-Sachs
lesion, postoperative range of motion in both shoulders, Rowe score,
Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling
Index Score of Remplissage grade according to magnetic resonance imaging
scans at the last follow-up.
Results:
There were 41 patients included with a mean age of 30 ± 7 years who underwent
the Hill-Sachs remplissage procedure using the double-pulley technique with
2 anchors (n = 21; group DA) or the mattress suture technique with a single
anchor (n = 20; group SA). At the final follow-up, there were no significant
differences between the groups regarding the Instability Severity Index
Score (P = .134), the Sugaya index (P =
.538), sports participation (P = .41), the radiological
measurement of the Hill-Sachs lesion (P = .803), or the
Rowe score (P = .182). However, there were significant
differences between the groups in the Walch-Duplay score (P
= .012), American Shoulder and Elbow Surgeons score (P =
.005), and Filling Index Score of Remplissage grade (P =
.015), favoring group DA, as well as differences in external rotation in a
neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3°
[group DA]; P = .003) and at 90° of abduction (external
rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P
= .006), favoring group SA.
Conclusion:
In the remplissage procedure, the double-pulley technique provided better
filling of the lesion and improvement in functional scores, but external
rotation was limited compared with the mattress suture technique.
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