The Effect of the Remplissage Procedure on Shoulder Stability and Range of Motion
Author(s)
Type
Journal Article
Abstract
Background: The remplissage procedure may be performed as an adjunct to Bankart repair to treat recurrent glenohumeral
dislocation associated with an engaging Hill-Sachs humeral head defect. The purpose of this in vitro biomechanical
study was to examine the effects of the remplissage procedure on glenohumeral joint motion and stability.
Methods: Cadaveric shoulders (n = 8) were mounted on a biomechanical testing apparatus that applies simulated loads
to the rotator cuff and the anterior, middle, and posterior heads of the deltoid muscle. Testing was performed with the
shoulder intact, after creation of the Bankart lesion, and after repair of the Bankart lesion. In addition, testing was
performed after Bankart repair with and without remplissage in shoulders with 15% and 30% Hill-Sachs defects. Shoulder
motion and glenohumeral translation were recorded with an optical tracking system. Outcomes measured included
stability (joint stiffness and defect engagement) and internal-external glenohumeral rotational motion in adduction and in
90 of composite shoulder abduction.
Results: In specimens with a 15% Hill-Sachs defect, Bankart repair combined with remplissage resulted in a significant
reduction in internal-external range of motion in adduction (15.1 ± 11.1, p = 0.039), but not in abduction (7.7 ± 9.9, p =
0.38), compared with the intact condition. In specimens with a 30% Hill-Sachs defect, repair that included remplissage also
significantly reduced internal-external range of motion in adduction (14.5 ± 11.3, p = 0.049) but not in abduction (6.2 ±
9.3, p = 0.60). In specimens with a 15% Hill-Sachs defect, addition of remplissage significantly increased joint stiffness
compared with isolated Bankart repair (p = 0.038), with the stiffness trending toward surpassing the level in the intact
condition (p = 0.060). In specimens with a 30% Hill-Sachs defect, addition of remplissage restored joint stiffness to
approximately normal (p = 0.41 compared with the intact condition). All of the specimens with a 30% Hill-Sachs defect
engaged and dislocated after Bankart repair alone. The addition of remplissage was effective in preventing engagement and
dislocation in all specimens. None of the specimens with a 15% Hill-Sachs defect engaged or dislocated after Bankart repair.
Conclusions: In this experimental model, addition of remplissage provided little additional benefit to a Bankart repair in
specimens with a 15% Hill-Sachs defect, and it also reduced specific shoulder motions. However, Bankart repair alone
was ineffective in preventing engagement and recurrent dislocation in specimens with a 30% Hill-Sachs defect. The
addition of remplissage to the Bankart repair in these specimens prevented engagement and enhanced stability, although
at the expense of some reduction in shoulder motion.
Clinic
dislocation associated with an engaging Hill-Sachs humeral head defect. The purpose of this in vitro biomechanical
study was to examine the effects of the remplissage procedure on glenohumeral joint motion and stability.
Methods: Cadaveric shoulders (n = 8) were mounted on a biomechanical testing apparatus that applies simulated loads
to the rotator cuff and the anterior, middle, and posterior heads of the deltoid muscle. Testing was performed with the
shoulder intact, after creation of the Bankart lesion, and after repair of the Bankart lesion. In addition, testing was
performed after Bankart repair with and without remplissage in shoulders with 15% and 30% Hill-Sachs defects. Shoulder
motion and glenohumeral translation were recorded with an optical tracking system. Outcomes measured included
stability (joint stiffness and defect engagement) and internal-external glenohumeral rotational motion in adduction and in
90 of composite shoulder abduction.
Results: In specimens with a 15% Hill-Sachs defect, Bankart repair combined with remplissage resulted in a significant
reduction in internal-external range of motion in adduction (15.1 ± 11.1, p = 0.039), but not in abduction (7.7 ± 9.9, p =
0.38), compared with the intact condition. In specimens with a 30% Hill-Sachs defect, repair that included remplissage also
significantly reduced internal-external range of motion in adduction (14.5 ± 11.3, p = 0.049) but not in abduction (6.2 ±
9.3, p = 0.60). In specimens with a 15% Hill-Sachs defect, addition of remplissage significantly increased joint stiffness
compared with isolated Bankart repair (p = 0.038), with the stiffness trending toward surpassing the level in the intact
condition (p = 0.060). In specimens with a 30% Hill-Sachs defect, addition of remplissage restored joint stiffness to
approximately normal (p = 0.41 compared with the intact condition). All of the specimens with a 30% Hill-Sachs defect
engaged and dislocated after Bankart repair alone. The addition of remplissage was effective in preventing engagement and
dislocation in all specimens. None of the specimens with a 15% Hill-Sachs defect engaged or dislocated after Bankart repair.
Conclusions: In this experimental model, addition of remplissage provided little additional benefit to a Bankart repair in
specimens with a 15% Hill-Sachs defect, and it also reduced specific shoulder motions. However, Bankart repair alone
was ineffective in preventing engagement and recurrent dislocation in specimens with a 30% Hill-Sachs defect. The
addition of remplissage to the Bankart repair in these specimens prevented engagement and enhanced stability, although
at the expense of some reduction in shoulder motion.
Clinic
Date Issued
2012-06-06
Date Acceptance
2012-01-01
Citation
Journal of Bone and Joint Surgery - American Volume, 2012, 94 (11), pp.1003-1012
ISSN
0021-9355
Publisher
Journal of Bone and Joint Surgery, Inc
Start Page
1003
End Page
1012
Journal / Book Title
Journal of Bone and Joint Surgery - American Volume
Volume
94
Issue
11
Copyright Statement
Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated
Subjects
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Surgery
ORTHOPEDICS
SURGERY
HILL-SACHS LESION
ANTERIOR GLENOHUMERAL INSTABILITY
HUMERAL HEAD
BANKART REPAIR
EXTERNAL ROTATION
BONE DEFECTS
JOINT
DISLOCATION
KINEMATICS
MANAGEMENT
Publication Status
Published