Pascal Boileau1, Walter B McClelland1, Kieran O'Shea1, Pablo Vargas1, Miguel Pinedo1, Jason Old2, Matthias A Zumstein3. 1. Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet 2, Medical University of Nice-Sophia-Antipolis, 151 route de St Antoine de Ginestière, 06200 Nice, France. E-mail address for P. Boileau: boileau.p@chu-nice.fr. 2. University of Manitoba, Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB R3M 3E4, Canada. 3. Department of Orthopaedics and Traumatology, University of Bern, Inselspital, 3010 Bern, Switzerland.
Abstract
INTRODUCTION: Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability. STEP 1 ANTERIOR CAPSULOLABRAL MOBILIZATION AND GLENOID PREPARATION: Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect. STEP 2 PREPARATION OF THE HILL-SACHS DEFECT: With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus. STEP 3 REMPLISSAGE WITH THE POSTERIOR ASPECT OF THE CAPSULE AND INFRASPINATUS TENDON: Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm). STEP 4 ANTERIOR BANKART REPAIR: Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. STEP 5 POSTOPERATIVE REHABILITATION PROTOCOL: Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months. RESULTS: In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability. STEP 1 ANTERIOR CAPSULOLABRAL MOBILIZATION AND GLENOID PREPARATION: Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect. STEP 2 PREPARATION OF THE HILL-SACHS DEFECT: With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus. STEP 3 REMPLISSAGE WITH THE POSTERIOR ASPECT OF THE CAPSULE AND INFRASPINATUS TENDON: Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm). STEP 4 ANTERIOR BANKART REPAIR: Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. STEP 5 POSTOPERATIVE REHABILITATION PROTOCOL: Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months. RESULTS: In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.IndicationsContraindicationsPitfalls & Challenges.
Authors: Pascal Boileau; Kieran O'Shea; Pablo Vargas; Miguel Pinedo; Jason Old; Matthias Zumstein Journal: J Bone Joint Surg Am Date: 2012-04-04 Impact factor: 5.284