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Infraspinatus Advancement via Remplissage Improves Dynamic Anterior Stability but Reduces External Rotation Moment
Shangcheng Wang1, Kerry Danelson2, Nahir Habet1
1Atrium Health Musculoskeletal Institute, Charlotte, NC.
Journal of Shoulder and Elbow Surgery
|July 30, 2026
Summary
Remplissage with infraspinatus incorporation increases posterior shoulder stability but may limit external rotation. Surgeons must consider these biomechanical trade-offs during arthroscopic Bankart repair for recurrent instability.
Area of Science:
- Orthopedic Surgery
- Biomechanics
- Computational Modeling
Background:
- Arthroscopic Bankart repair with remplissage reduces shoulder instability.
- Mechanisms and potential overconstraint effects of remplissage are not fully understood.
- This study computationally investigates infraspinatus incorporation in remplissage.
Purpose of the Study:
- Quantify changes in the infraspinatus force vector with remplissage.
- Evaluate the effect of infraspinatus incorporation on anterior shoulder stability.
- Assess the impact on shoulder external rotation limitations.
Main Methods:
- Computational modeling of 16 shoulders using ArtiSynth software.
- Simulated infraspinatus tendon fixation at varying medialized positions on the Hill-Sachs lesion.
- Analyzed force vectors and moment arms in the 90/90 abduction and external rotation (ABER) position.
Main Results:
- Medialization of infraspinatus insertion significantly increased its posterior force vector.
- Each millimeter of medialization correlated with a 2.3% increase in posterior force.
- External rotation and abduction moment arms were reduced by 6.9% and 6.1%, respectively.
Conclusions:
- Infraspinatus incorporation in remplissage enhances posterior force in the ABER position.
- Advancement of the infraspinatus tendon reduces external rotation and abduction moment arms.
- Surgeons should weigh the biomechanical benefits and drawbacks of infraspinatus medialization during remplissage.
