Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence

Abstract

Background: This paper presents the results of arthroscopic remplissage in the treatment of traumatic anterior shoulder instability in a difficult subgroup of patients with both glenoid bone loss and a significant Hill-Sachs lesion.

Methods: From March 2002 through May 2010, 270 patients were treated surgically for anterior shoulder instability. Of the surgical procedures performed, 59 patients (21.9%) with anterior instability and Bigliani grade IIIA (glenoid deficiency <25%) were treated with this technique. The average age was 33 years (range, 17-67 years); there were 48 men and 11 women. The procedure consisted of an arthroscopic posterior capsulodesis and infraspinatus tenodesis that filled the Hill-Sachs lesion and a concomitant arthroscopic anterior Bankart repair. Forty-five patients (76%) were available for follow-up ranging from 2 to 10 years (average, 58 months). All patients were evaluated by use of the Rowe and Constant scores. Twenty-seven patients were also evaluated by use of the Western Ontario Shoulder Instability Index.

Results: Of the 45 patients, 2 (4.4%) had recurrent instability after traumatic dislocations; one was due to a basketball injury, and the other was reinjured by wrestling. At final follow-up, the median and mean scores ± standard deviation were as follows: Rowe score, 95, 92 ± 12; Constant score, 95, 92 ± 10; and Western Ontario Shoulder Instability Index, 110, 224 ± 261. All patients, except the traumatic dislocations, had no reoperations or complications.

Conclusion: This procedure provides an effective arthroscopic approach in those cases of anterior shoulder instability that present with the combination of glenoid bone loss (grade IIIA) and a Hill-Sachs lesion.

Level of evidence: Level IV, case series, treatment study.

Keywords: Traumatic shoulder instability; anterior glenoid defect; arthroscopic Hill-Sachs remplissage; engaging Hill-Sachs lesion.