Arthroscopic Bankart Repair Combined with Remplissage Technique for the Treatment of Anterior Shoulder Instability with Engaging Hill-Sachs Lesion

Zhu, Ye; Lu, Yi; Zhang, Jin; Shen, Jincheng; Jiang, Chunyan

doi:10.1177/0363546511400018

Cited by 133 publications

(143 citation statements)

References 46 publications

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“…Purchase, Sahajpal et al [80] reported a recurrent instability rate of 7% at 2 years post surgery with no significant loss in range of motion. Other studies report a loss of external rotation between 1.9 to 8 degrees [81,82] . A 90% return to sport has been reported following the procedure.…”

Section: %-40% Bone Lossmentioning

confidence: 91%

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Ramhamadany

Modi

2016

WJO

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The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.

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Section: %-40% Bone Lossmentioning

confidence: 91%

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Ramhamadany

Modi

2016

WJO

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“…Multiple other authors have studied these same concepts of tendon healing and their effect on external rotation. Zhu et al 13 and Merolla et al 18 both found 100% healing rates on postoperative evaluation with magnetic resonance imaging and ultrasonography. These authors also measured infraspinatus strength, showing it remained normal after the postoperative recovery period.…”

Section: Discussionmentioning

confidence: 98%

“…Their reported loss of motion is greater than many of the other studies that report either no loss of external rotation 15 or less than 2 . 13 Two recent systematic reviews by Buza et al 14 and Leroux et al 16 demonstrated a 2.6 loss in external rotation and no significant loss in external rotation, respectively; the authors concluded clinically that loss of external rotation has not been proven to be an issue after remplissage.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

Alexander

Beicker

Tokish

2016

Arthroscopy Techniques

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Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We present the arthroscopic remplissage technique originally described by Koo and Burkhart et al. with a modification in the percutaneous anchor placement and suture tying that is reproducible and effective. We percutaneously place 2 suture anchors, which require no additional suture passing across the tissue, to create a double pulley technique, filling the defect with posterior capsule and rotator cuff. Therefore, the Hill-Sachs defect becomes extra-articular, eliminating the potential engagement of the anterior glenoid and contribution to recurrence of instability. This technique is applicable broadly for most Hill-Sachs lesions that need addressing. By not having to pass or shuttle any suture through tissue after anchor placement and by eliminating the necessity to go subacromially to retrieve or tie suture, the technique saves time and improves reproducibility. The compression of tissue into the Hill Sachs surface area also is improved by double-reinforced suturing through the double-pulley technique. The combination of these advantages creates a sound and efficient technique for remplissage.

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“…Many techniques have been described to reduce the impression fracture, and the most popular surgical options are remplissage-i.e. capsulotenodesis to the humeral bony defect, which can be done arthroscopically [28][29][30]. Generally, the redislocation rate using the remplissage technique is low and ranges between 2 % and 6 % [30], whereas a slight restriction in external rotation of approximately 10°appears.…”

Section: Discussionmentioning

confidence: 99%

“…capsulotenodesis to the humeral bony defect, which can be done arthroscopically [28][29][30]. Generally, the redislocation rate using the remplissage technique is low and ranges between 2 % and 6 % [30], whereas a slight restriction in external rotation of approximately 10°appears. Boileau et al [29] showed that this limited range of motion did not affect sports activity and that 90 % of patients were able to return to sports, although only 68 % at a preinjury level.…”

Section: Discussionmentioning

confidence: 99%

Balloon osteoplasty—a new technique for minimally invasive reduction and stabilisation of Hill–Sachs lesions of the humeral head: a cadaver study

Sandmann

Ahrens

Schaeffeler

et al. 2012

International Orthopaedics (SICOT)

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Purpose Traumatic shoulder dislocation may be complicated by concomitant bony injury of the glenoid rim or the humeral head. In Hill-Sachs lesions, reconstruction techniques vary widely and range from open reduction to tendon transposition or humeral head derotation. These operations are extensive and have questionable outcomes. With the expertise from vertebral compression fracture reduction by kyphoplasty, we examined in a cadaver feasibility study whether reduction of the Hill-Sachs lesion via hydraulic lift might be an anatomical and minimally invasive treatment option. We postulated that the use a of a balloon-assisted kyphoplasty reduction could achieve almost anatomical correction of the defect. Methods We created Hill-Sachs lesions in six humeral specimens and performed a computed tomography (CT) scan before and after reduction with the kyphoplasty system. The entry point at the greater tuberosity and balloon positioning was visualised by fluoroscopy. The size of the HillSachs lesion before and after reduction was measured using CT scans in the axial orientation. Results Using the balloon kyphoplasty system, we achieved a statistically significant reduction (80 % ) of the Hill-Sachs lesion. Conclusion In a preliminary cadaver study we show that using a balloon kyphoplasty system might be an alternative treatment option for Hill-Sachs lesions, with reduced collateral damage that can occur with other minimally invasive techniques. Future work is needed to evaluate the technique under arthroscopic conditions.

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Arthroscopic Bankart Repair Combined with Remplissage Technique for the Treatment of Anterior Shoulder Instability with Engaging Hill-Sachs Lesion

Abstract: Arthroscopic Bankart repair combined with Hill-Sachs remplissage can restore shoulder stability without significant impairment of shoulder function in patients with engaging Hill-Sachs lesions.

Cited by 133 publications

References 46 publications

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

Balloon osteoplasty—a new technique for minimally invasive reduction and stabilisation of Hill–Sachs lesions of the humeral head: a cadaver study

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