Humeral Head Bone Defects: Remplissage, Allograft, and Arthroplasty

Assessment of coincidence and defect sizes in Bankart and Hill–Sachs lesions after anterior shoulder dislocation: a radiological study

“…8,18-21 Different factors determining the size of a Hill-Sachs lesion are discussed in the literature: upward forces that cause a shoulder dislocation are cited alongside ligament instability. In cases of ligament hyperlaxity, less force is necessary to cause a shoulder dislocation, 17,22 and, in consequence, the size of any Hill-Sachs lesion is smaller owing to lower shear and impression forces. This may explain the lower probability of suffering a Hill-Sachs lesion in the recurrence group.…”

Remplissage Versus Latarjet for Engaging Hill-Sachs Defects Without Substantial Glenoid Bone Loss: A Biomechanical Comparison

“…Generally, defects measuring less than 20% of humeral head width are adequately stabilized with an isolated soft tissue Bankart repair [7,19]. However, for defects measuring 20% to 40%, there are minimal comparative data on existing treatment options to support one over another [1,19,22]. The various procedures can be separated into two classes: anatomic procedures, which attempt to restore normal proximal humeral anatomy, and nonanatomic procedures, which attempt to limit engagement of the Hill-Sachs defect [1,19,21,22,27].…”

“…However, for defects measuring 20% to 40%, there are minimal comparative data on existing treatment options to support one over another [1,19,22]. The various procedures can be separated into two classes: anatomic procedures, which attempt to restore normal proximal humeral anatomy, and nonanatomic procedures, which attempt to limit engagement of the Hill-Sachs defect [1,19,21,22,27]. Of the nonanatomic procedures, proponents of remplissage favor this procedure because it can be done arthroscopically, heals predictably with minimal reported limitations on ROM, and is associated with success rates of up to 98% [2,22].…”

“…Treating the associated Hill-Sachs defect, however, can dramatically reduce recurrence rates from as high as 67% down to 2% to 5% [3,5]. Procedures described to address this humeral head defect include allograft humeral head reconstruction, rotational proximal humeral osteotomies, osteochondral transplant, or even humeral head replacement [1]. Two additional procedures, the remplissage procedure and Latarjet coracoid transfer, are aimed at limiting defect engagement and subsequent dislocation.…”

The Effect of the Remplissage Procedure on Shoulder Stability and Range of Motion

“…Arthroscopic repairs of Bankart lesions that do not address an engaging Hill-Sachs defect when one is present have been associated with higher failure rates 2,5,7 . Several surgical procedures have been described for the management of engaging Hill-Sachs defects, including humeral rotational osteotomy, humeroplasty, reconstruction with osteochondral allograft, osteochondral transplantation, and partial or complete humeral head replacement 4,[8][9][10][11][12][13][14][15][16][17][18] . In 2008, Purchase et al described a technique of arthroscopic posterior capsulodesis and infraspinatus tenodesis into the Hill-Sachs defect to prevent engagement 19 .…”