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Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique
Pascal Boileau, MD; Walter B. McClelland Jr., MD; Kieran O’Shea, MD, FRCS(I); Pablo Vargas, MD; Miguel Pinedo, MD; Jason Old, MD, FRCSC; Matthias A. Zumstein, MD

Overview

Introduction Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability.

Step 1: Anterior Capsulolabral Mobilization and Glenoid Preparation Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the “engaging” nature of the Hill-Sachs defect.

Step 2: Preparation of the Hill-Sachs Defect With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus.

Step 3: Remplissage with the Posterior Aspect of the Capsule and Infraspinatus Tendon Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm).

Step 4: Anterior Bankart Repair Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair.

Step 5: Postoperative Rehabilitation Protocol Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months.

Results In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.

Indications

Contraindications

Pitfalls & Challenges

Introduction

Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the …


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