The shoulder remplissage procedure for Hill-Sachs defects: does technique matter?

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Sports Medicine

Background:

• Hill-Sachs (HS) lesions are common in shoulder instability.
• Remplissage techniques aim to improve stability by augmenting the posterior rotator cuff.

Purpose of the Study:

• To biomechanically evaluate the effects of three distinct remplissage techniques on shoulder stability and range of motion (ROM) in a simulated Hill-Sachs instability model.

Main Methods:

• Cadaveric shoulder specimens were tested using an active shoulder simulator.
• Three remplissage techniques (T1: defect valley anchors, T2: humeral head rim anchors, T3: valley anchors with medial suture) were applied to 15% and 30% HS defects.
• Outcomes measured included joint stability, internal-external rotation range of motion (IE-ROM), and joint stiffness.

Main Results:

• All three remplissage techniques enhanced shoulder stability.
• Techniques T1 and T2 showed no significant difference in IE-ROM reduction.
• Technique T3 resulted in the greatest reduction in IE-ROM and significantly increased joint stiffness, particularly in larger defects.

Conclusions:

• All evaluated remplissage techniques effectively improve shoulder stability.
• Remplissage procedures inherently restrict ROM and increase joint stiffness.
• Technique T3, involving medial suture placement, yields the most pronounced increase in joint stiffness and motion restriction.