title: The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions.
abstract: OBJECTIVE
  The purpose of this study was to determine the biomechanical effects of the remplissage repair combined with Bankart repair for engaging Hill-Sachs lesions on range of motion (ROM), translation, and glenohumeral kinematics.
  
  
  METHODS
  Six cadaveric shoulders were tested using a custom shoulder testing system. ROM, kinematics, and anterior-posterior (AP) and superior-inferior glenohumeral translations were quantified at 0° and 60° glenohumeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40 % Hill-Sachs lesion, Bankart repair, Bankart repair with remplissage, and remplissage repair alone.
  
  
  RESULTS
  Humeral external rotation (ER) and total range of motion increased significantly after the creation of the Bankart lesion at both 0° and 60° abduction. The Bankart repair restored ER to intact values at 0° and 60° abduction, and the addition of the remplissage repair did not significantly alter range of motion from the Bankart repair alone. AP translation increased following the creation of the Bankart and Hill-Sachs lesions and was restored with the Bankart repair; the remplissage did not alter translation from the Bankart repair alone. At maximum ER at 60° abduction, the apex of the humeral head shifted posteriorly and inferiorly with remplissage repair.
  
  
  CONCLUSIONS
  The addition of the remplissage procedure combined with Bankart repair for treatment of large Hill-Sachs lesions had no statistically significant effect on ROM or translation, but altered the kinematics of the glenohumeral joint. Thus, by addressing the humeral bone defect following an anterior shoulder dislocation, the remplissage technique with concurrent Bankart repair may be a relatively minimally invasive option for converting engaging Hill-Sachs lesions to non-engaging and promoting shoulder stability, though further biomechanical and clinical studies are warranted.
authors.affiliation: Department of Orthopaedic Surgery, The University of Southern California, Los Angeles, CA, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Argintar
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Heckmann
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, The University of Southern California, Los Angeles, CA, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Tibone
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA. tqlee@va.gov.
authors.forename: Thay Q
authors.initials: TQ
authors.lastname: Lee
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D002102:Cadaver; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000473:pathology / Q000601:surgery; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D012399:Rotation; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing
keywords: Biomechanics; Cadaver study; Hill–Sachs lesion; Instability; Remplissage