Anterior shoulder instability with engaging Hill–Sachs defects: a comparison of arthroscopic Bankart repair with and without posterior capsulodesis

Abstract

Case-control study, Level III.

Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability

“…The depth of the Hill-Sachs lesion was the only preoperative predictive parameter of failure of this series. One explanation would be related to non-healing of the capsulotenodesis into the Hill-Sachs lesion, leaving the Bankart repair alone to stabilise the shoulder [7,8,15,16]. According a biomechanical model of the capsulotenodesis fixation into a Hill-Sachs lesion, we have shown that a deep and narrow defect made the fixation more critical (see Appendix).…”

Comparative Study on the Management of Glenohumeral Joint Dislocation : Closed Reduction vs. Arthroscopic Remplissage with Bankart Lesion Repair

“…These factors determine the risk for reinjury that is associated with an increase of the structural damage of both bony structures and soft tissues In nearly all cases of anterior dislocation, a disruption of the labrum takes place, the so-called Bankart lesion. In most cases of acute and recurrent dislocation, a posterolateral fracture of the head, known as Hill-Sachs lesion, is seen [4,[8][9][10][11][12][13][14][15].…”

“…The ''engaging'' Hill-Sachs lesion refers to one that engages the rim of the glenoid when the shoulder is abducted and externally rotated. Engaging Hill-Sachs lesions lead to recurrent instability and a high rate of failure when treated with arthroscopic Bankart repair alone [4,[8][9][10][11][12][13][14][15]. Failure to address this humeral osseous defect during arthroscopic and open stabilization surgery for glenohumeral instability leads to an increased rate of recurrence.…”

“…Both Palmer and Widen and Burkhart and De Beer described the ''engaging'' Hill-Sachs lesion, which refers to one that engages the rim of the glenoid when the shoulder is physiologically abducted and externally rotated. Engaging Hill-Sachs lesions lead to recurrent instability and a high rate of failure when treated with arthroscopic Bankart repair alone [4,[8][9][10][11][12][13][14][15] In 1972 Connolly proposed a surgical procedure which is filling of the humeral head defect with the posterior aspect of the capsule and the infraspinatus tendon to decrease the likelihood of postoperative redislocation. In 2004, Wolf et al described, as a modification of Connolly's open surgical method, the arthroscopic technique of Hill-Sachs ''remplissage'' which involves advancing the infraspinatus tendon and posterior capsule to the osseous surface of the Hill-Sachs lesion with anchor sutures, performed in combination with Bankart repair.…”

“…In 2004, Wolf et al described, as a modification of Connolly's open surgical method, the arthroscopic technique of Hill-Sachs ''remplissage'' which involves advancing the infraspinatus tendon and posterior capsule to the osseous surface of the Hill-Sachs lesion with anchor sutures, performed in combination with Bankart repair. Koo et al described a modification of this technique in which the sutures are tied over the infraspinatus tendon rather than over the muscle [4,5,11,15].…”