Abstract
BackgroundLarge 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.MethodsPatients 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.ResultsThirteen 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.ConclusionArthroscopic 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.
Highlights
Hill–Sachs lesions are posterior-superolateral bone defects of the humeral head that can be observed in 45–70% of first episodes of shoulder dislocation and about 100% of recurrent dislocations [1,2,3]
The secondary objectives were to: Assess the range of motion (ROM) of the shoulder in external rotation measured with the arm at the side (ER1) and with the arm at 90° of abduction (ER2) Measure the infraspinatus isometric strength Establish the healing of the capsulotendodesis through the use of Magnetic resonance imaging (MRI) Quantify the percentage of the Hill–Sachs lesion filled by the tendon, considering the number of anchors used Evaluate the presence of tendinopathies, rotator cuff tears, and bone edema of the humeral head
All the shoulders examined underwent arthroscopic Bankart repair associated with Hill–Sachs remplissage performed using only one double-loaded suture anchor (Corkscrew 5.0 mm, Arthrex, Naples, FL, USA)
Summary
Hill–Sachs lesions are posterior-superolateral bone defects of the humeral head that can be observed in 45–70% of first episodes of shoulder dislocation and about 100% of recurrent dislocations [1,2,3]. Di Giacomo et al [6] have recently introduced the concept of the "glenoid track,” which is the contact area between the humeral head and the scapular glenoid during shoulder movement in maximum abduction and external rotation This concept associates the extent of the glenoid bone defect (bony Bankart) with the location, extent, and depth of the humeral bone defect (Hill–Sachs). In 2004, Wolf and Pollack proposed a new procedure for these cases called remplissage, which consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon to "fill" the humeral bone defect. This technique converts the Hill–Sachs from an intra-articular lesion to an extra-articular one, preventing its engagement with the anterior portion of the scapular glenoid (Fig. 1) [9]. 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
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