Arthroscopic remplissage for the treatment of anterior glenohumeral instability with engaging Hill-Sachs lesions: should it be performed first?

Abstract

Background Posterolateral compression fracture of the humeral head (a Hill-Sachs lesion) is a common finding associated with anterior shoulder instability. Burkhart and De Beer were the first to describe engaging Hill-Sachs lesion. They concluded that arthroscopic Bankart repair in the presence of such bone deficiencies is likely to fail and requires open surgery. Purchase and colleagues presented a procedure that consists of an arthroscopic posterior capsulodesis and infraspinatus tenodesis to fill (remplissage) the Hill-Sachs lesion in addition to an arthroscopic Bankart repair. Objectives The purpose of this study was to evaluate the outcome of arthroscopic remplissage in cases of recurrent shoulder dislocation with engaging Hill-Sachs lesion using one anchor for the remplissage. Patients and methods A total of 15 patients (12 male and three female) with recurrent anterior shoulder instability and engaging Hill-Sachs lesion underwent arthroscopic remplissage procedure with capsulolabral repair. The mean age of the patients was 28 years and the mean follow-up period was 12 months. Two patients had concomitant superior lateral anterior posterior tear (SLAP) lesion type 1. Results On the basis of the preoperative MRI, 13 patients had a large Hill-Sachs defect. The dominant arm was involved in eight (53%). The mean surgery duration was ~100 min. Overall, a mean of four anchors were used, including those for Bankart repair, with one anchor used for the remplissage procedure. Rowe score for instability increased from a mean of 12.3 preoperatively to 86.3 at 6 months postoperatively. None of the patients included in this study complained of decreased shoulder range of motion. One patient complained of painful abduction of the affected shoulder. Conclusion The remplissage technique achieves good results in patients with anterior shoulder dislocation associated with engaging humeral head defects with concomitant Bankart lesion at short-term follow-up. The Bankart repair can be completed first followed by remplissage.