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The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill–Sachs lesions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the biomechanical effects of the remplissage repair combined with Bankart repair for engaging Hill–Sachs lesions on range of motion (ROM), translation, and glenohumeral kinematics.

Methods

Six cadaveric shoulders were tested using a custom shoulder testing system. ROM, kinematics, and anterior–posterior (AP) and superior–inferior glenohumeral translations were quantified at 0° and 60° glenohumeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40 % Hill–Sachs lesion, Bankart repair, Bankart repair with remplissage, and remplissage repair alone.

Results

Humeral external rotation (ER) and total range of motion increased significantly after the creation of the Bankart lesion at both 0° and 60° abduction. The Bankart repair restored ER to intact values at 0° and 60° abduction, and the addition of the remplissage repair did not significantly alter range of motion from the Bankart repair alone. AP translation increased following the creation of the Bankart and Hill–Sachs lesions and was restored with the Bankart repair; the remplissage did not alter translation from the Bankart repair alone. At maximum ER at 60° abduction, the apex of the humeral head shifted posteriorly and inferiorly with remplissage repair.

Conclusions

The addition of the remplissage procedure combined with Bankart repair for treatment of large Hill–Sachs lesions had no statistically significant effect on ROM or translation, but altered the kinematics of the glenohumeral joint. Thus, by addressing the humeral bone defect following an anterior shoulder dislocation, the remplissage technique with concurrent Bankart repair may be a relatively minimally invasive option for converting engaging Hill–Sachs lesions to non-engaging and promoting shoulder stability, though further biomechanical and clinical studies are warranted.

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Acknowledgments

The institution of one or more authors has received funding for this study by a grant from the VA Rehabilitation Research and Development Merit Review. All hardware was donated by Arthrex (Arthrex, Naples, Fl).

Ethical standard

Basic science cadaver study, IRB approval was waived.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The University of Southern California, Los Angeles, CA, USA

    Evan Argintar & James E. Tibone

  2. Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA

    Nathanael Heckmann, Lawrence Wang & Thay Q. Lee

Authors
  1. Evan Argintar
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  2. Nathanael Heckmann
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  3. Lawrence Wang
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  4. James E. Tibone
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Correspondence to Thay Q. Lee.

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Argintar, E., Heckmann, N., Wang, L. et al. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill–Sachs lesions. Knee Surg Sports Traumatol Arthrosc 24, 585–592 (2016). https://doi.org/10.1007/s00167-014-3092-4

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  • DOI: https://doi.org/10.1007/s00167-014-3092-4

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