Outcomes of the Remplissage Procedure and Its Effects on Return to Sports

Liu, Joseph N.; Garcia, Grant H.; Wu, Hao-Hua; Huffman, G. Russell; Kelly, John D.

doi:10.1177/0363546515626199

Cited by 116 publications

(58 citation statements)

References 42 publications

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“…Three-dimensional CT reconstruction is currently considered the gold standard for the evaluation of bone loss, 10,53 although MRI has also demonstrated consistent correlation with CT in many studies. 27,34 Several techniques for classifying attritional glenoid bone loss 6,7 and Hill-Sachs lesions 51 have been described, and more than 20% to 25% anterior-inferior glenoid loss has been suggested as a critical threshold for increased failure with isolated labral repair. 13,33,50 More recently, the lower limit of this bone loss has been questioned, with so-called “subcritical” bone loss of 13.5% leading to suboptimal outcomes with arthroscopic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…While the glenoid has traditionally been the area of focus, characteristics of the Hill-Sachs lesion have recently received increased attention. 15,27 Though often ill-defined, clinically significant humeral-based defects may be effectively treated with remplissage as a nonanatomic complement to arthroscopic anterior stabilization (Figure 2). A randomized clinical trial comparing remplissage and Bankart reconstruction to Bankart alone demonstrated no recurrences in the combined group compared with 20% recurrence in the isolated group.…”

Section: Managementmentioning

confidence: 99%

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Anterior Shoulder Instability in the Military Athlete

Waterman

Owens

Tokish

2016

Sports Health: A Multidisciplinary Approach

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Context:Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability.Evidence Acquisition:A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability.Study Design:Clinical review.Level of Evidence:Level 4.Results:The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or “off-track” engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered.Conclusion:Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Anterior Shoulder Instability in the Military Athlete

Waterman

Owens

Tokish

2016

Sports Health: A Multidisciplinary Approach

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“…7,14,17 Even with small losses of only 2° to 8°, 3,4,19 the effects may have a greater impact in overhead athletes. 9 One explanation for external rotation loss may be due to overmedialization of suture placement. Elkinson et al 7 found placing anchors 1 cm more medial to the desired position in the posterior capsule significantly increased joint stiffness and reduced range of motion.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Suture Passage During Arthroscopic Remplissage—What Anatomic Landmarks Can Improve It?

Garcia

Degen

Liu

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Recent data suggest that inaccurate suture passage during remplissage may contribute to a loss of external rotation, with the potential to cause posterior shoulder pain because of the proximity to the musculotendinous junction.Purpose:To evaluate the accuracy of suture passage during remplissage and identify surface landmarks to improve accuracy.Study Design:Descriptive laboratory study.Methods:Arthroscopic remplissage was performed on 6 cadaveric shoulder specimens. Two single-loaded suture anchors were used for each remplissage. After suture passage, position was recorded in reference to the posterolateral acromion (PLA), with entry perpendicular to the humeral surface. After these measurements, the location of posterior cuff penetration was identified by careful surgical dissection.Results:Twenty-four sutures were passed in 6 specimens: 6 sutures (25.0%) were correctly passed through the infraspinatus tendon, 12 (50%) were through the infraspinatus muscle or musculotendinous junction (MTJ), and 6 (25%) were through the teres minor. Suture passage through the infraspinatus were on average 25 ± 5.4 mm inferior to the PLA, while sutures passing through the teres minor were on average 35.8 ± 5.7 mm inferior to the PLA. There was an odds ratio of 25 (95% CI, 2.1-298.3; P < .001) that the suture would be through the infraspinatus if the passes were less than 3 cm inferior to the PLA. Sutures passing through muscle and the MTJ were significantly more medial than those passing through tendon, measuring on average 8.1 ± 5.1 mm lateral to the PLA compared with 14.5 ± 5.5 mm (P < .02). If suture passes were greater than 1 cm lateral to the PLA, it was significantly more likely to be in tendon (P = .013).Conclusion:We found remplissage suture passage was inaccurate, with only 25% of sutures penetrating the infraspinatus tendon. Passing sutures 1 cm lateral and within 3 cm inferior of the PLA improves the odds of successful infraspinatus tenodesis. We recommend this “safe zone” to improve the odds of infraspinatus tenodesis during remplissage. These results may help improve remplissage techniques and prevent previously reported complications, including external rotation loss and pain from myodesis.

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“…Garcia et al reported an average ASES score post-remplissage of 89.3 at an average follow-up time of 60.7 months. 10 Merolla et al used the same procedure and reported a mean Constant-Murley score of an increase from 62.9 + 7.1 preoperatively to 90 + 5.2 at a median follow-up of 39.5 months. 11 Similarly, Wolf and Arianjam reported a postoperative mean Constant score of 92 + 10 at an average follow-up of 58 months.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] However, many patients also experience limitation in external and internal rotation of the joint following this procedure. 6,[9][10][11] Garcia et al reported that 66.5% of patients experienced a reduced range of motion in throwing after the remplissage procedure. 10 This limitation in shoulder range of motion has also been shown in cadaveric studies.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of the reverse McLaughlin procedure for Hill–Sachs lesions in anterior shoulder instability

Han

Chin

Tan

et al. 2018

J Orthop Surg (Hong Kong)

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Introduction: Engaging Hill-Sachs lesions in recurrent anterior shoulder dislocation have been managed with the remplissage procedure. Clinical and cadaveric studies have reported limitation of rotation after this procedure. We introduce the reverse McLaughlin procedure where the infraspinatus and the underlying capsule are detached and approximated into the Hill-Sachs defect with transosseous sutures. This is a preliminary report using this technique. Methods: Seventeen patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion underwent a Bankart repair and remplissage procedure (n ¼ 9) or the reverse McLaughlin procedure (n ¼ 8). Patients were evaluated using the SF-36, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Clinical assessment of the shoulders was also performed. Results: At the final follow-up, all patients in both groups achieved comparable clinical outcome scores. No significant differences were reported in the range of motion of the shoulders between the two groups. There was one dislocation of the operated shoulder in each group after an injury. Conclusion: The reverse McLaughlin procedure for engaging Hill-Sachs lesions is simple, easy to perform, and associated with functional outcomes and range of motion at least equivalent to those obtained via the remplissage technique. It may be an alternative to the latter procedure. Level of Evidence: III, Retrospective Comparative Study

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Outcomes of the Remplissage Procedure and Its Effects on Return to Sports

Cited by 116 publications

References 42 publications

Anterior Shoulder Instability in the Military Athlete

Anterior Shoulder Instability in the Military Athlete

Accuracy of Suture Passage During Arthroscopic Remplissage—What Anatomic Landmarks Can Improve It?

Clinical outcomes of the reverse McLaughlin procedure for Hill–Sachs lesions in anterior shoulder instability

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