The Effect of the Remplissage Procedure on Shoulder Stability and Range of Motion

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

“…Biomechanical studies on cadavers have reported loss of external rotation, including Grimberg et al, 19 who found a 11.7 loss in external rotation after Bankart plus remplissage compared with the intact cadaveric specimen; however, their Bankart plus remplissage restored stiffness equal to the intact model unlike Bankart repair alone in cadavers with concurrent Bankart and Hill-Sachs defects. The same results of improved stiffness and stability with loss of external rotation in the cadaveric model were found by Giles et al 20 and Elkinson et al 21 The clinical studies measuring range of motion, however, have not demonstrated this to be a significant problem. In their original publication, Boileau et al 7 reported 8 loss of external rotation; however, they concluded the slight restriction in external rotation did not significantly affect return to sports, including those that involved overhead throwing.…”

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

“…However, Elkinson et al [7] noted in their biomechanical study of the remplissage procedure that internal-external rotation was found to be reduced with the humerus adducted. Similar to their results in abduction, our testing produced no effect, likely due to a decrease in rotator cuff tension in the abducted position [7].…”

“…However, Elkinson et al [7] noted in their biomechanical study of the remplissage procedure that internal-external rotation was found to be reduced with the humerus adducted. Similar to their results in abduction, our testing produced no effect, likely due to a decrease in rotator cuff tension in the abducted position [7]. Conversely, after the Latarjet procedure, there was no effect on internal-external rotation ROM in adduction, while in abduction a 29% decrease in this ROM relative to the HillSachs defect state was noted.…”

“…While studies have shown the role these defects play in perpetuating instability [3,4], a consensus on critical defect values and the best treatment options are lacking [12,19]. Generally, defects measuring less than 20% of humeral head width are adequately stabilized with an isolated soft tissue Bankart repair [7,19]. However, for defects measuring 20% to 40%, there are minimal comparative data on existing treatment options to support one over another [1,19,22].…”

“…The anterior, lateral, and posterior heads of the deltoid muscle were each loaded with 5 N [11,18,23,25]. Applied loads were determined from previous studies with similar testing protocols, as well as from literature examining the effect of muscular loading on joint compression [7,9,10,17,24,25].…”