title: Anatomical and functional results after arthroscopic Hill-Sachs remplissage.
abstract: BACKGROUND
  Large osseous defects of the posterosuperior aspect of the humeral head can engage the glenoid rim and cause recurrent instability after arthroscopic Bankart repair for glenohumeral dislocation. Filling of the humeral head defect with the posterior aspect of the capsule and the infraspinatus tendon (i.e., Hill-Sachs remplissage) has recently been proposed as an additional arthroscopic procedure. Our hypothesis is that the capsulotenodesis heals in the humeral bone defect without a severe adverse effect on shoulder mobility, allowing return to preinjury sports activity.
  
  
  METHODS
  Of 459 patients operated on for recurrent traumatic anterior shoulder instability, forty-seven (10.2%) underwent arthroscopic Bankart repair combined with Hill-Sachs remplissage with use of suture anchors. All had a large Hill-Sachs lesion (Calandra grade III), engaging over the glenoid rim, without substantial glenoid bone loss. Nine patients had had prior unsuccessful surgery to address glenohumeral instability (three Bankart and six Bristow-Latarjet procedures). The average age at the time of surgery (and standard deviation) was 29 ± 5.4 years. Postoperatively, comparative shoulder motion was precisely measured with use of digital photographic images. Capsulotenodesis healing was assessed on a computed tomography (CT) arthrogram (n = 38) or magnetic resonance image (MRI) (n = 4). The mean duration of follow-up was twenty-four months.
  
  
  RESULTS
  Healing of the posterior aspect of the capsule and the infraspinatus tendon into the humeral defect was observed in all forty-two patients who underwent postoperative imaging, and thirty-one (74%) had a remplissage of ≥75%. Compared with the normal (contralateral) side, the mean deficit in external rotation was 8° ± 7° with the arm at the side of the trunk and 9° ± 7° in abduction at the time of the last follow-up. Of forty-one patients involved in sports, thirty-seven (90%) were able to return postoperatively and twenty-eight (68%) returned to the same level of sports, including those involving overhead activities. Ninety-eight percent (forty-six) of the forty-seven patients had a stable shoulder at the time of the last follow-up.
  
  
  CONCLUSIONS
  Arthroscopic Hill-Sachs remplissage, performed in combination with a Bankart repair, is a potential solution for patients with a large engaging humeral head bone defect but no substantial glenoid bone loss. The posterior capsulotenodesis heals predictably in the humeral defect. The slight restriction in external rotation (approximately 10°) does not significantly affect return to sports, including those involving overhead activities. The procedure, which may also be useful for revision of previous failed glenohumeral instability surgery, is not indicated for patients with glenoid bone deficiency.
authors.affiliation: Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet-University of Nice Sophia-Antipolis, 151, Route de St Antoine de Ginesti`ere, 06202 Nice, France. boileau.p@chu-nice.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.forename: Kieran
authors.initials: K
authors.lastname: O'Shea
authors.forename: Pablo
authors.initials: P
authors.lastname: Vargas
authors.forename: Miguel
authors.initials: M
authors.lastname: Pinedo
authors.forename: Jason
authors.initials: J
authors.lastname: Old
authors.forename: Matthias
authors.initials: M
authors.lastname: Zumstein
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology / Q000601:surgery; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012008:Recurrence; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000601:surgery*; D053441:Suture Anchors; D013709:Tendon Transfer / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult