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. 2019 Feb;54(1):13-19.
doi: 10.1016/j.rbo.2017.10.010. Epub 2019 Mar 1.

Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability

Flávio de Oliveira França  1   2 , André Couto Godinho  1   2   3 , Diego Pedrosa Capitol Carneiro Leal  1   2 , Mateus Matos Mantovani  1   2 , Rafael Rodrigues Frazão  1   2 , Ricardo Ferreira Mariz  1   2
Affiliations

Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability

Flávio de Oliveira França et al. Rev Bras Ortop (Sao Paulo). 2019 Feb.

Abstract

Objective: To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength.

Methods: Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder.

Results: Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe and Walch-Duplay scores, respectively. A mean difference of - 1 kg in the strength of the operated limb was observed when compared with the contralateral limb ( p < 0.001), as well as a mean difference of 10° in external rotation 1 and 2 ( p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle.

Conclusion: The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.

Keywords: Bankart lesions; arthroscopy; joint instability; recurrence; shoulder.

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Conflict of interest statement

Conflitos de Interesse Os autores declaram não haver conflitos de interesse.

Figures

Fig. 1
Fig. 1
Anchor positioning at Hill-Sachs lesion.
Fig. 2
Fig. 2
U-suture prepared for capsulotenodesis.
Fig. 3
Fig. 3
Intra-articular view of the filling of the Hill-Sachs lesion defect.
Fig. 4
Fig. 4
A, partial filling with small residual defect of the Hill-Sachs lesion on magnetic resonance imaging; B, complete filling.
Fig. 1
Fig. 1
Posicionamento da âncora na lesão de Hill-Sachs.
Fig. 2
Fig. 2
Preparo do ponto em U para capsulotenodese.
Fig. 3
Fig. 3
Visualização intra-articular do preenchimento da lesão de Hill-Sachs.
Fig. 4
Fig. 4
(A) preenchimento parcial com defeito residual pequeno da lesão de Hill-Sachs visualizado pela ressonância magnética; (B) preenchimento completo.
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