title: The effect of the remplissage procedure on shoulder range of motion: a cadaveric study.
abstract: OBJECTIVE
  The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position.
  
  
  METHODS
  HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°).
  
  
  RESULTS
  For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle.
  
  
  CONCLUSIONS
  In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position.
  
  
  CONCLUSIONS
  The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance.
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Rei
authors.initials: R
authors.lastname: Omi
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Hooke
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Kristin D
authors.initials: KD
authors.lastname: Zhao
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Matsuhashi
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Akira
authors.initials: A
authors.lastname: Goto
authors.affiliation: Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: John W
authors.initials: JW
authors.lastname: Sperling
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
authors.forename: Scott P
authors.initials: SP
authors.lastname: Steinmann
authors.affiliation: Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Itoi
authors.affiliation: Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A. Electronic address: an@mayo.edu.
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D053441:Suture Anchors