The shoulder remplissage procedure for Hill-Sachs defects: does technique matter?

Iia Elkinson, Joshua W Giles, Harm W Boons, Kenneth J Faber, Louis M Ferreira, James A Johnson, George S Athwal
Journal of Shoulder and Elbow Surgery 2013, 22 (6): 835-41

BACKGROUND: This biomechanical study evaluated the effects of 3 remplissage techniques on shoulder stability and motion in a Hill-Sachs (HS) instability model.

MATERIALS AND METHODS: Cadaveric forequarters were tested on an active shoulder simulator. Three remplissage techniques were performed for 15% and 30% HS defects. Testing conditions included intact and 15% and 30% HS defects, and the 3 remplissage techniques: T1, anchors in the defect valley; T2, anchors in humeral head rim; and T3, anchors in valley with medial suture placement. Outcomes included stability, internal-external rotation range of motion (IE-ROM), and joint stiffness.

RESULTS: All remplissage techniques improved shoulder stability. In 15% HS defects tested in adduction, T3 significantly reduced IE-ROM (P = .037), whereas T1 and T2 did also (mean IE-ROM reductions: T1, 14°; T2, 11°; T3, 21°), but not to significance (P ≥ .088). In abduction, no significant reductions in IE-ROM occurred (P ≥ .060). In 30% HS defects tested in adduction (mean reduction IE-ROM: T1, 11°; T2, 19°; T3, 28°) and abduction (mean reduction: T1, 9°; T2, 15°; T3, 21°), all techniques significantly reduced IE-ROM (P ≤ .046). All techniques increased joint stiffness from 100% to 320% beyond the Bankart repair alone. A significant increase in joint stiffness was observed for T3 compared with the 30% HS group (P = .004), whereas T2 trended toward an increase (P = .078). There was no significant increase in joint stiffness with T1 (P = .249).

CONCLUSIONS: All remplissage techniques enhanced shoulder stability, restricted ROM, and increased joint stiffness. No significant differences were found between anchors placed in the valley (T1) vs those placed in the humeral head rim (T2). Medial suture placement (T3) resulted in the greatest joint stiffness values and mean restriction in motion.

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