Hill-sachs "remplissage": an arthroscopic solution for the engaging hill-sachs lesion.
We present an arthroscopic technique used to treat traumatic shoulder instability in patients with glenoid bone loss and a large Hill-Sachs lesion. The procedure consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon to fill the Hill-Sachs lesion. With the patient in the lateral decubitus position, a posterior portal is established at the lateral aspect of the convexity of the humeral head that is centered over the lesion. After anterior-inferior and anterior-superior portals have been established, the camera is placed in the anterior-superior portal. The Hill-Sachs lesion is freshened with a bur through the posterior portal. A cannula is inserted in the posterior portal through the deltoid but not through the infraspinatus or capsule, and an anchor is placed in the inferior aspect of the humeral lesion. A penetrating grasper is passed through the tendon and posterior capsule, 1 cm inferior to the initial portal entry site to pull 1 suture limb. A second anchor is placed superiorly, and 1 suture limb is similarly passed. The inferior suture is tied first with the knots remaining extra-articular, pulling the infraspinatus and capsule into the lesion. After completion, the Bankart lesion can then be repaired.
California Pacific Medical Center, San Francisco, California 94115, USA. rpurchase@gmail.com
Robert J
RJ
Purchase
Eugene M
EM
Wolf
E Rhett
ER
Hobgood
Michael E
ME
Pollock
Chad C
CC
Smalley
D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000601:surgery*