Remplissage Versus Latarjet for Engaging Hill-Sachs Defects Without Substantial Glenoid Bone Loss: A Biomechanical Comparison

Abstract

Background Recurrent shoulder instability

Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability

“…The depth of the Hill-Sachs lesion was the only preoperative predictive parameter of failure of this series. One explanation would be related to non-healing of the capsulotenodesis into the Hill-Sachs lesion, leaving the Bankart repair alone to stabilise the shoulder [7,8,15,16]. According a biomechanical model of the capsulotenodesis fixation into a Hill-Sachs lesion, we have shown that a deep and narrow defect made the fixation more critical (see Appendix).…”

“…According to these findings , the indication of BHSR is debatable in case of deep and engaging Hill-Sachs lesion. Degen et al [8] proved that either Latarjet and BHSR procedures reduced frequency of dislocation in a 25% ofhumeral defect model on cadavers. However, Latarjet seemed to stabilise more specimens than BHSR (94% vs 84% oftesting scenarios), and thereby could be proposed as an alternative procedure.…”

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

“…Biomechanically, in vitro, the remplissage and Latarjet both stabilized against dislocation and increased stiffness. 5 In a systematic review, Longo et al 4 compared management options of remplissage, humeral osteochondral grafts, arthroplasty, and Weber osteotomy. They found arthroplasty to have the greatest recurrence rates and lowest outcomes, whereas remplissage demonstrated the lowest recurrence rates, lowest complications, and greatest outcome scores.…”

“…These techniques include remplissage, humeral osteochondral grafts, osteotomy, arthroplasty, Latarjet, and open Bankart procedures. 4,5 Traditional techniques have focused on an open capsular shift and the Latarjet. In 2008, Purchase et al 6 described the remplissage as a technique to address humeral-sided bone loss in instability cases in conjunction with Bankart repair.…”

Arthroscopic Remplissage for Engaging Hill-Sachs Lesions in Patients With Anterior Shoulder Instability

“…7 Biomechanical comparison of remplissage versus Latarjet transfer showed similar reductions in instability and maintenance of motion for the 2 procedures in patients with less than 25% glenoid bone loss. 8 The capsule-only remplissage has the added benefit of minimizing undue stress on the rotator cuff, but this technique can be adapted to incorporate the infraspinatus if the surgeon believes it is indicated. Ultimately, when appropriate steps are followed (Table 2), this technique provides orthopaedic surgeons with an additional option for treating patients with complex anterior shoulder instability.…”