Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect

Abstract

Objectives:In the present study, the efficacy of a posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect.Methods:8 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 created: 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 measures for each specimen.Results:Significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both PL and RM groups compared to the HSD group throughout most of the joint loads tested (p < 0.05) [Figure 1], but no significant differences were noted between PL and RM at any load. The RM group had significantly less normalized ER at 60° of abduction compared to the HSD and PL groups (p < 0.05). There were no differences in IR between the groups. All 8 HSD specimens engaged, while no specimens in the RM and PL groups engaged (p < 0.001).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 to remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of external rotation compared to remplissage without any significant limitation of internal rotation.