Hill-Sachs “Remplissage:” An Arthroscopic Solution For the Engaging Hill-Sachs Lesion

Authors: Wolf, M. Pollack, C. Smalley

References: Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 23, Issue 6, Pages e1-e2 E.

Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 23, Issue 6, Pages e1-e2 E. Wolf, M. Pollack, C. Smalley

Purpose
Anterior traumatic shoulder instability, presenting with both glenoid bone loss and a Hill-Sachs lesion, has been shown to be recalcitrant to arthroscopic stabilization. This paper presents the results of an arthroscopic technique that is used to treat those difficult instability patients who present with anterior inferior glenoid loss and a Hill-Sachs lesion. The technique is a combined arthroscopic posterior capsulodesis and infraspinatus tenodesis using sutures and suture anchors that fills (Remplissage: french.: to fill) the Hill-Sachs lesion.

Methods
Twenty-two patients were treated with this technique between May 2002 and August 2004. Twenty patients were available for follow-up which ranged from 25 to 57 months. Eleven responded via a questionnaire posted on our web site. Nine were interviewed by telephone and all were rated by the previously published Subjective Shoulder Score. In addition to the Remplissage, all patients were treated concomitantly with a standard anterior suture anchor technique. Seven patients had had prior stabilization surgery. The system uses six categories to evaluate the outcomes: pain, stability, activity, strength, range of motion, overall satisfaction.

Results
Twenty patients were available for follow-up. There were 15 excellent, 3 good and 2 poor results. Two patients suffered traumatic redislocations, one due to a motorcycle accident and the other was reinjured wrestling. Both were treated with Latarjet procedures. Eighteen of twenty patients were very satisfied. All seven patients who had had prior failed open or arthroscopic stabilization surgeries, had good or excellent results without recurrence. One patient experienced post-operative stiffness that responded to non-operative measures. Two patients had secondary arthroscopic procedures: one for a painful posterior labral tear, the other for a prominent fixation device. These two procedures allowed second looks that both demonstrated the structural effect of the Remplissage, with the capsule and tendons healed into the Hill-Sachs lesion.

Conclusions
This procedure provides an effective arthroscopic alternative to open bone or bone-tendon transfers (Latarjet) in cases of anterior shoulder instability that presents with the combination of glenoid bony loss and a Hill-Sachs lesion. The results of this technique in this difficult subset of traumatic anterior shoulder instability patients are significantly better (10% recurrence rate) than those reported by prior authors (67% recurrence rate) using an arthroscopic Bankart alone to treat this type of pathology.