Is arthroscopic remplissage a tenodesis or capsulomyodesis? An anatomic study.
OBJECTIVE
Arthroscopic remplissage of a Hill-Sachs lesion is classically described as a capsulotenodesis of the infraspinatus within the posterolateral humeral head. The aim of this cadaveric study was to evaluate the anatomic relationship between the position of anchors and sutures placed for remplissage and the infraspinatus and teres minor. The hypothesis was that remplissage actually corresponds to a capsulomyodesis of the infraspinatus and teres minor muscles.


METHODS
A two-anchor arthroscopic remplissage was performed followed by open dissection of ten fresh-frozen human cadaveric shoulders. The exit point of sutures related to muscle-tendon unit as well as the distance between the anchors and the rotator cuff was measured.


RESULTS
The superior sutures were localized generally in the infraspinatus, near the musculotendinous junction. The inferior sutures passed through the teres minor muscle in seven of ten cases. The distance between the superior and inferior anchors and the posterolateral greater tuberosity was 14 ± 2 and 12 ± 3 mm, respectively.


CONCLUSIONS
Arthroscopic remplissage is a capsulomyodesis of infraspinatus and teres minor rather than a capsulotenodesis of the infraspinatus alone as previously believed. Muscular damage may explain posterosuperior pain observed in patients who underwent remplissage.
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland. Alexandre.laedermann@gmail.com.|Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. Alexandre.laedermann@gmail.com.|Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 21, Switzerland. Alexandre.laedermann@gmail.com.
Alexandre
A
Lädermann
Policlinico San Donato, Università degli studi di Milano, piazza Malan 1, San Donato Milanese, Italy.
Paolo
P
Arrigoni
Clinique des Cèdres, Avenue Albert Londres, Echirolles, France.
Johannes
J
Barth
Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina.
Pablo
P
Narbona
Arthrex Inc., Naples, FL, USA.
Bryan
B
Hanypsiak
The San Antonio Orthopaedic Group, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Stephen S
SS
Burkhart
Southern Oregon Orthopedics, Medford, OR, USA.|Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA.
Patrick J
PJ
Denard
D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000033:anatomy & histology / Q000601:surgery; D017746:Joint Capsule / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000601:surgery*; D017006:Rotator Cuff / Q000033:anatomy & histology / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D013710:Tendons / Q000033:anatomy & histology / Q000601:surgery; D053656:Tenodesis / Q000379:methods
Anatomic study; Anatomy; Anterior shoulder instability; Capsulodesis; Hill–Sachs remplissage; Humeral fracture; Tenodesis