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Is arthroscopic remplissage a tenodesis or capsulomyodesis? An anatomic study
Alexandre Lädermann1,2,3, Paolo Arrigoni4, Johannes Barth5
1Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland. Alexandre.laedermann@gmail.com.
Summary
Arthroscopic remplissage for Hill-Sachs lesions involves the infraspinatus and teres minor muscles, not just the infraspinatus tendon. This capsulomyodesis may explain posterosuperior pain after the procedure.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Anatomy
Background:
- Arthroscopic remplissage is a surgical technique for Hill-Sachs lesions.
- It is traditionally described as a capsulotenodesis of the infraspinatus tendon.
Purpose of the Study:
- To anatomically evaluate the relationship between anchors/sutures used in arthroscopic remplissage and the infraspinatus and teres minor muscles.
- To test the hypothesis that remplissage is a capsulomyodesis of these muscles.
Main Methods:
- Performed arthroscopic remplissage using two anchors on ten fresh-frozen cadaveric shoulders.
- Followed by open dissection to measure suture exit points and anchor proximity to the rotator cuff.
Main Results:
- Superior sutures were located in the infraspinatus near the musculotendinous junction.
- Inferior sutures passed through the teres minor in 70% of cases.
- Anchors were positioned 14±2 mm (superior) and 12±3 mm (inferior) from the greater tuberosity.
Conclusions:
- Arthroscopic remplissage acts as a capsulomyodesis of the infraspinatus and teres minor muscles.
- This differs from the traditional view of a capsulotenodesis involving only the infraspinatus tendon.
- Potential muscular damage during the procedure may account for posterosuperior pain in patients.
