The Shoulder Remplissage Procedure for Hill-Sachs Lesions: Does Technique Matter?

INTRODUCTION: Recently, the Remplissage procedure, which involves insetting the infraspinatus tendon and posterior joint capsule into an engaging HillSachs lesion has begun to gain popularity. Due to the relative infancy of this technique, a standardized procedure for suture anchor and suture placement has not been defined. Therefore, the purpose of this biomechanical study was to compare three Remplissage techniques by evaluating their effects on joint stiffness and motion. METHODS: Cadaveric forequarters (n=7, average age=71) were mounted on a custom active biomechanical shoulder simulator capable of loading the infraspinatus & teres minor, subscapularis, supraspinatus, and the three deltoid heads (Figure 1). The Remplissage techniques were implemented for 15 and 30% Hill-Sachs lesions with one and two anchors placed, respectively. Three randomly ordered Remplissage techniques were conducted: T1anchor(s) in the valley of the defect, T2anchor(s) in the rim of the humeral head; T3anchor(s) in the valley with medial suture placement. Passive ROM and shoulder stability were evaluated using a repeated measures design with the states of: intact, Bankart lesion and repair, 15 and 30% humeral head defects, and T1, T2, and T3 Remplissage techniques. Outcomes were assessed in adduction and 90 combined abduction. Combined shoulder abduction was achieved using a glenohumeral-scapulothoracic rhythm of 2:1. Outcome variables included stiffness, and internal/external (IE) rotational range of motion (ROM). Joint stiffness was tested in neutral and 60 of external humeral rotation using an anteriorly direct load up to 80N. Humeral IE rotation ROM was determined using a predefined clinically relevant applied torque. Data were normalized to intact in order to facilitate comparison between Remplissage techniques and tested using One-Way ANOVAs with significance set to p<0.05.