Long-term outcomes of arthroscopic Bankart repair and Hill-Sachs remplissage for bipolar bone defects

Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation

The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.

Infraspinatus function impairment after arthroscopic Bankart repair with Hill Sachs remplissage. Isokinetic, functional, and radiographic analysis

PURPOSE

Arthroscopic Bankart repair with Hill Sachs remplissage (BHSR) is an option for anterior shoulder instability with humeral defect. Our hypothesis was that infraspinatus capsulo-tenodesis is an effective solution, with good clinical results and no consequences on shoulder strength and ranges of motion.

METHODS

We performed a retrospective case-control study involving 22 patients operated with arthroscopic BHSR. We compared isokinetic evaluation of both shoulders using a dynanometer in concentric, eccentric force and endurance. Ranges of motion were measured using a goniometer and compared to the contralateral unaffected side. Functional assessment included Constant, Rowe, Walch and Duplay and WOSI scores. Healing and fatty degeneration were analyzed with magnetic resonance imaging.

RESULTS

At mean 37.2 months follow-up, 21 patients (95.4%) were satisfied or very satisfied with the intervention. Range of motion in external rotation of the affected side decreased by 10.8° in adduction and 6° at 90° of abduction (p<0.05). Deficit in external rotation strength of the affected side greater than 15% was found in all isokinetic tests (p<0.05). Walch and Duplay, Rowe, WOSI and adjusted Constant average scores were respectively 71.05±14.1 (40-90), 67.63±19.7 (15-100), 34.6%±19.9 (8.43-76.23) and 69.8±13.57 (36.7-101). Postoperative MRI showed good capsulo-tenodesis healing without infraspinatus muscle fatty degeneration.

CONCLUSION

Arthroscopic BHSR provides satisfactory functional outcomes but significant infraspinatus functional impairments in both strength and ranges of motion in external rotation.

LEVEL OF EVIDENCE

III; case-control study.

R, Valero-Cifuentes G, Campagnoli A, Hermida M, Rius X. Arthroscopic All-Inside Remplissage Technique With Knotless Tape Bridge for Hill-Sachs Lesions

The arthroscopic remplissage procedure has been described to successfully treat engaging Hill-Sachs lesions and improve shoulder stability. Several variations of this technique have been described, including remplissage with 1 or 2 knotted or knotless anchors, remplissage with double or triple bridging pulleys, and remplissage with or without a subacromial view. However, most techniques use anchors in combination with round sutures. This article describes an all-arthroscopic articular knotless remplissage technique using a strong, flat, double-strand suture tape bridge fixed with 2 small anchors under direct joint visualization and reduction of the capsule and infraspinatus without requiring a subacromial view.

Arthroscopic Autologous Iliac Crest Grafting Results in Similar Outcomes and Low Recurrence Compared to Remplissage Plus Bankart Repair for Anterior Shoulder Instability With Bipolar Bone Defects

PURPOSE

To compare the functional outcomes, range of motion (ROM), recurrence rates, and complication rates of arthroscopic autologous iliac crest grafting (AICG) and Remplissage plus Bankart repair (RB) for anterior shoulder instability with bipolar bone defects.

METHODS

This study enrolled patients undergoing arthroscopic AICG or RB with 13.5-25% glenoid bone defect combined with Hill-Sachs lesion between January 2013 and April 2020, who had a minimum 2-year follow-up. Patient-reported outcomes were evaluated by Subjective Shoulder Value (SSV), Oxford Shoulder Instability Score (OSIS), Rowe score, Constant score, and visual analog scale (VAS) for pain. Active ROM, return to sports, recurrence, self-reported apprehension, and complications were recorded.

RESULTS

This study included 60 patients, including 28 AICG (Group A) and 32 RB (Group R). Mean glenoid bone defect was similar (17.7% ± 3.1% vs 16.6% ± 2.4%; P = .122). Both groups showed significant postoperative improvement in Rowe score, SSV, OSIS, and Constant score. No significant difference was found in postoperative Rowe Score (87.7 vs 85.2; P = .198). A total of 20/28 (71.4%) patients in Group A versus 26/32 (81.3%) patients in Group R met the Patient Acceptable Symptomatic State determined by VAS pain score (P = .370). Both groups showed high return-to-sports rates (67.8% vs 71.8%; P = .735) and slightly decreased ROM. There were two cases of recurrence in Group A versus one in Group R (P = .594). Group R had insignificantly higher positive self-reported apprehension rate (40.6% vs 17.9%; P = .055).

CONCLUSION

For anterior shoulder instability with bipolar bone defects, both arthroscopic AICG and RB can result in satisfactory clinical outcomes, good postoperative ROM, and low recurrence and complication rates.

LEVEL OF EVIDENCE

Level III; retrospective cohort study.

Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability: Current and Evolving Concepts

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A Hill-Sachs lesion (HSL) is a compression fracture on the posterolateral humeral head that can increase the risk of recurrent shoulder instability after isolated arthroscopic Bankart repair.

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Remplissage involves capsulotenodesis of the infraspinatus tendon and posterior capsule into the HSL to prevent its engagement with the glenoid rim through extra-articular conversion and restraint against humeral head anterior translation.

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The glenoid track concept can be applied preoperatively and intraoperatively to evaluate risk of recurrence and help direct clinical management options for recurrent shoulder instability.

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Recent literature supports expanding indications for remplissage to include patients with on-track HSLs who are at increased risk of recurrence including collision athletes, military personal, and patients with joint hyperlaxity.

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New techniques and suture constructs have demonstrated improved biomechanical strength while avoiding the need to access the subacromial space.

Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed

Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.