The Evaluation of Arthroscopic Remplissage by High-Resolution Magnetic Resonance Imaging

Park, Min Jung; Garcia, Grant H.; Malhotra, Amit D.; Major, Nancy M.; Tjoumakaris, Fotios P.; Kelly, John D.

doi:10.1177/0363546512456974

Cited by 56 publications

(48 citation statements)

References 17 publications

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“…Also, the size of the Hill Sachs deformity in all patients was measured on axial, coronal, and sagittal cuts where the largest value was recorded on each axis. This MRI measurement is similar to previously published work by Park et al [10].…”

Section: Methodssupporting

confidence: 91%

Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage

et al. 2015

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Background: There is little comparative longterm clinical data comparing Bankart repair alone to the addition of remplissage. Questions/Purposes: Our purpose was to compare results of patients with significant humeral head lesions and who underwent either isolated arthroscopic Bankart repair or remplissage. Methods: This is a retrospective cohort study of 14 isolated arthroscopic Bankart and 10 remplissage repairs all with large engaging Hill-Sachs (HS) lesions. Average follow-up was 40.72 months (26.3-51.1) in the Bankart group and 31.55 months (24.1-39.9) in the remplissage group. Surgical failure was defined as a dislocation or subluxation. Groups were matched on handedness, age within 3 years, and HS lesion size. Glenoid bone loss and HS size were measured on MRI. Additionally, WOSI and DASH scores were obtained. Results: The average age at surgery was 26.0 years (17.8-41

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Section: Methodssupporting

confidence: 91%

Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage

et al. 2015

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“…In our study, recurrence of instability was noted in two patients. Park et al25) reported that there was evidence of tendon incorporation and filling into the Hill-Sachs defect following an arthroscopic remplissage, and patients were satisfied with the procedure and demonstrated minimal loss of external rotation (average, 5.8°) at an early follow-up. We also observed infraspinatus tendon was incorporated into the Hill-Sachs defect after the remplissage procedure and there was slight loss of external rotation.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

Cha

Lee

et al. 2016

Clin Orthop Surg

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BackgroundRecurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit.MethodsEngaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging.ResultsThe average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II.ConclusionsCompared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

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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.…”

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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The Evaluation of Arthroscopic Remplissage by High-Resolution Magnetic Resonance Imaging

Cited by 56 publications

References 17 publications

Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage

Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

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

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