Results From Filling “Remplissage” Arthroscopic Technique for Recurrent Anterior Shoulder Dislocation

Abstract

Objective: To evaluate the clinical result from the filling (“remplissage”) technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. Methods: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the “engaging” sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7%) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. Results: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p > 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p > 0.001). The measurements of external and internal rotation at abduction of 90° after the operation were 63.5° (45° to 90°) and 73° (50° to 92°) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. Conclusion: Over the short term, the filling (“remplissage”) arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions.

Instabilidade glenoumeral anterior: Revisão sistemática dos desfechos usados no Brasil

“…The Rowe score for instability 28 was used in 9 studies 16 17 18 19 22 23 24 26 27 (75%), whereas 7 studies 17 19 20 22 23 24 26 (58%) used the University of California, Los Angeles Shoulder Rating Scale (UCLA), 29 and 1 paper 16 (8%) evaluated its results with the Walch-Duplay Score ( Fig. 3 ).…”

“…In addition, 12 of 116 patients (10.3%) submitted to the Latarjet surgery still presented shoulder instability. Among papers reporting this complication, only 5, 21 22 23 26 (42%) defined which patients had postoperative apprehension, subluxation, or dislocation episodes. Other reported complications included pain, adhesive capsulitis, prominent anchors, and coracoid process pseudarthrosis.…”

“…There were no prospective randomized studies or prospective cohorts, and 83% of the papers referred to case series (level IV of evidence). 17 18 20 21 22 23 24 25 26 27…”

New quantitative method to measure the Hill-Sachs lesion: validation of Hardy's radiographic method for MRI/AMRI

“…In turn, Gracitelli et al 21 evaluated the percentage of HSL involvement (in MRI or CT-arthrogram), considering as parameters the radius of the humeral head and the depth of the lesion in the same axial section. In the present authors’ view, this measurement will only be overestimated if the largest radius of the humeral head is at the same height as the greatest depth of the HSL.…”

Traumatic anterior instability of the shoulder

“…The results were improved Rowe scores from 22.5 to 80.5, and UCLA from 18.0 to 31.1 with two cases of recurrence, one dislocation and one subluxation. 76 …”