Anatomical And Functional Results After Arthroscopic Hill-sachs Remplissage

Background:Large osseous defects of the posterosuperior aspect of the humeral headcan engage the glenoid rim and cause recurrent instability after arthroscopic Bankartrepair for glenohumeral dislocation. Filling of the humeral head defect with theposterior aspect of the capsule and the infraspinatus tendon (i.e., Hill-Sachs remplissage)has recently been proposed as an additional arthroscopic procedure. Our hypothesis isthat the capsulotenodesis heals in the humeral bone defect without a severe adverseeffect on shoulder mobility, allowing return to preinjury sports activity.Methods: Of459patients operated on for recurrent traumatic anterior shoulderinstability, forty-seven (10.2%) underwent arthroscopic Bankart repair combined withHill-Sachs remplissage with use of suture anchors. All had a large Hill-Sachs lesion(Calandra grade III), engaging over the glenoid rim, without substantial glenoid boneloss. Nine patients had had prior unsuccessful surgery to address glenohumeralinstability (three Bankart and six Bristow-Latarjet procedures). The average age at thetime of surgery (and standard deviation) was29±5.4years. Postoperatively,comparative shoulder motion was precisely measured with use of digital photographicimages. Capsulotenodesis healing was assessed on a computed tomography (CT)arthrogram (n=38) or magnetic resonance image (MRI)(n=4). The mean duration offollow-up was twenty-four months.Results: Healing of the posterior aspect of the capsule and the infraspinatus tendon intothe humeral defect was observed in all forty-two patients who underwent postoperativeimaging, and thirty-one (74%) had a remplissage of75%. Compared with the normal(contralateral) side, the mean deficit in external rotation was8°±7°with the arm at theside of the trunk and9°±7°in abduction at the time of the last follow-up. Of forty-onepatients involved in sports, thirty-seven (90%) were able to return postoperatively andtwenty-eight (68%) returned to the same level of sports, including those involvingoverhead activities. Ninety-eight percent (forty-six) of the forty-seven patients had a stable shoulder at the time of the last follow-up.Conclusions: Arthroscopic Hill-Sachs remplissage, performed in combination with aBankart repair, is a potential solution for patients with a large engaging humeral headbone defect but no substantial glenoid bone loss. The posterior capsulotenodesis healspredictably in the humeral defect. The slight restriction in external rotation(approximately10) does not significantly affect return to sports, including thoseinvolving overhead activities. The procedure, which may also be useful for revision ofprevious failed glenohumeral instability surgery, is not indicated for patients withglenoid bone deficiency.