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. 2022 Oct;10(10):899-910.
doi: 10.22038/ABJS.2022.64126.3085.

Arthroscopic Allograft Bone Block Procedure with Remplissage for Bipolar Lesions

Sahib D Memon  1 , Richard A C Dimock  1 , Jaymin Shah  2 , Sam Ajami  3 , Mohamed Imam  1   4 , A Ali Narvani  1
Affiliations

Arthroscopic Allograft Bone Block Procedure with Remplissage for Bipolar Lesions

Sahib D Memon et al. Arch Bone Jt Surg. 2022 Oct.

Abstract

Anterior shoulder instability with bone loss is a challenging condition. The two most performed procedures, Bankart repair & Latarjet, are not without issues. We describe a technique where arthroscopic free bone grafting was performed in conjunction with remplissage. We feel that this combined arthroscopic procedure offers advantages that include reduced risk of conventional Latarjet complications, including neurological deficits and metal hardware complications while preserving subscapularis and coracoid. Furthermore, these advantages may not come at the cost of compromised outcomes, particularly recurrence rate, as the remplissage may compensate for the possible lack of "sling effect" with free bone graft reconstruction.

Keywords: Bipolar lesions; Bone block; Hill Sachs lesions; Instability; Remplissage.

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Figures

Figure 1
Figure 1
Arthroscopic view of scope in the posterior portal showing the anterior labral tear and the HS lesion
Figure 2
Figure 2
Preoperative 3D reconstruction CT scans showing the glenoid bone loss & HS lesion
Figure 3
Figure 3
Arthroscopic view of scope in the anterosuperior portal showing the labral lesion, quality of the soft tissue, and the anterior glenoid morphology
Figure 4
Figure 4
Arthroscopic view of scope in the anterosuperior portal: anterior glenoid preparation
Figure 5
Figure 5
Arthroscopic view from anterosuperior portal: Introduction of the needle from the posterior portal aiming towards the center of the glenoid bone defect
Figure 6
Figure 6
Arthroscopic view from anterosuperior portal: Introduction of switching stick aiming towards the center of the glenoid bone defect
Figure 7
Figure 7
Arthroscopic view from anterosuperior portal: Introduction of guide and hook
Figure 8
Figure 8
Arthroscopic view from anterosuperior portal: Positioning of the hook
Figure 9
Figure 9
Arthroscopic view from anterosuperior portal: passage & positioning of cannulated sleeves
Figure 10
Figure 10
Schematic diagram showing the bone block guide and sleeves in place
Figure 11
Figure 11
Arthroscopic view from anterosuperior portal: 2.3 all suture anchors in the HS lesion
Figure 12
Figure 12
Arthroscopic view from posterior portal: 1.4 all suture anchors for the labral repair to be performed later
Figure 13
Figure 13
Arthroscopic view from anterosuperior portal: Retrieval of suture limbs
Figure 14
Figure 14
Schematic diagram showing the prepared bone block just before insertion with remplissage & glenoid anchors in situ
Figure 15
Figure 15
Schematic diagram demonstrating the passage of bone block through the metal cannula
Figure 16
Figure 16
Arthroscopic view from posterior portal: the passage of bone block graft
Figure 17
Figure 17
Arthroscopic view from anterosuperior portal: tensioning & securing the bone graft using posterior endo-buttons, tensioning device & Nice knot
Figure 18
Figure 18
Arthroscopic view from posterior portal: completion of labral repair over bone graft block
Figure 19
Figure 19
Arthroscopic view from anterosuperior portal: completion of remplissage
Figure 20
Figure 20
Final arthroscopic view from the anterosuperior portal with labral repair covering the bone block
Figure 21
Figure 21
Diagram showing bone block secured with labrum repaired over it & remplissage of HS lesion
Figure 22
Figure 22
Postoperative X-ray images (Axillary and Y views)
See this image and copyright information in PMC

References

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