The “Safe Zone” Technique Improves Suture Placement and Accuracy During Arthroscopic Remplissage

Abstract

In response to recent concerns about the accuracy of suture passage during arthroscopic remplissage, this study was conducted to determine whether a previously described "safe zone" technique can improve the accuracy of suture passage. A recommended safe zone technique was used for arthroscopic remplissage on 6 cadaveric specimens. The safe zone was described as a region at least 1 cm lateral and no greater than 3 cm distal to the posterolateral acromion. Results were compared with a control group of 6 specimens for which the safe zone technique was not used. For each group, 24 suture passes were performed. In the safe zone group, 83.3% (20 of 24) of sutures passed through the infraspinatus tendon. This was a significant improvement compared with the control group, in which only 25% (6 of 24) of sutures pierced the infraspinatus tendon (P<.01). In the safe zone group, 4.2% (1 of 24) of attempted suture passes were placed through the muscle or musculotendinous junction compared with 75% (18 of 24) in the control group (P<.01). Prevention of overmedialization improved significantly with the safe zone technique. In the safe zone group, both anchors had significantly more lateral (6 to 10 mm) suture passage compared with the control group (P<.01). The safe zone technique also showed greater precision of suture passes, and overall precision (SD) improved in 75% of passes. The safe zone technique significantly improved the accuracy of suture penetration into the infraspinatus tendon during arthroscopic remplissage. This reproducible method may help to prevent the reported complications of remplissage. [Orthopedics. 2017; 40(4):e598-e603.].

Arthroscopic Bankart and Remplissage for Anteroinferior Instability With Subcritical Bone Loss Has a Low Recurrence Rate

“…11,22,[27][28][29] Pain, mainly in the posterosuperior region of the shoulder, is also a potential drawback of the remplissage procedure. 24,[30][31][32] The purpose of our study is to demonstrate whether arthroscopic remplissage can achieve good outcomes without significantly impairing shoulder function.…”

Return to play following operative management of anterior shoulder instability in overhead athletes—A systematic review

“…However, this can be minimized by placing the anchor in the safe zone at least 1 cm lateral and no greater than 3 cm distal to the acromion, and avoiding over medialization. 50 Therefore, future biomechanical and clinical studies are needed to ascertain how the various operative techniques impact throwing motions or the sport-specific overhead abilities.…”

Anterior Shoulder Instability Part II—Latarjet, Remplissage, and Glenoid Bone-Grafting—An International Consensus Statement

“…Firstly, it was agreed that external range of motion loss is unlikely to be clinically significant but can be minimized by tenodesing the infraspinatus and posterior capsule within its safe-zone and not overmedializing the fixation. 54,55 Furthermore, it was agreed that there was no optimal fixation method and that if knotted anchors were used, they did not need to be tied under direct visualization. Finally, there was strong consensus agreement that a remplissage procedure need not alter the rehabilitation protocol of an isolated Bankart repair.…”