title: Decreased range of motion following arthroscopic remplissage.
abstract: The Hill-Sachs lesion is an impression fracture of the posterolateral margin of the humeral head that commonly results from impaction with the anterior glenoid rim during subluxation or dislocation of the shoulder. This bony defect has been implicated as an etiology of recurrent instability of the shoulder. The "remplissage" technique described by Wolf is an arthroscopic method of filling the Hill-Sachs defect via infraspinatus tenodesis and posterior capsulodesis. The purpose of this technique is to prevent recurrent instability by making the Hill-Sachs lesion extra-articular thereby eliminating engagement of the defect with the anterior glenoid rim. In addition, the infraspinatus tenodesis acts as a checkrein by preventing anterior translation of the humeral head. We report a complication of this recently described technique. A 28-year-old man who failed conservative management underwent an arthroscopic Bankart repair with a concomitant remplissage procedure. Two years postoperatively, the patient continued to struggle with the loss of external rotation. Conservative management with physical therapy and range of motion exercises failed. The patient was treated with an arthroscopic release of the tenodesed infraspinatus, which improved external rotation by 202 in circle intraoperatively. At 6 months postoperatively, the patient has maintained a significant increase external rotation. We hypothesize that the loss in external rotation occurred as a result of the tenodesis of the infraspinatus and posterior capsule into the Hill-Sachs defect. The tenodesed cuff and capsular tissue acted as a mechanical block to external rotation of the shoulder.
authors.affiliation: Baylor College of Medicine, Kelsey-Seybold Clinic, St. Luke's, Episcopal Hospital, Houston, Texas, USA.
authors.forename: Allen A
authors.initials: AA
authors.lastname: Deutsch
authors.forename: Derek G
authors.initials: DG
authors.lastname: Kroll
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D016059:Range of Motion, Articular