Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence.

Abstract

This paper presents the results of arthroscopic remplissage in the treatment of traumatic anterior shoulder instability in a difficult subgroup of patients with both glenoid bone loss and a significant Hill-Sachs lesion. From March 2002 through May 2010, 270 patients were treated surgically for anterior shoulder instability. Of the surgical procedures performed, 59 patients (21.9%) with anterior instability and Bigliani grade IIIA (glenoid deficiency <25%) were treated with this technique. The average age was 33 years (range, 17-67 years); there were 48 men and 11 women. The procedure consisted of an arthroscopic posterior capsulodesis and infraspinatus tenodesis that filled the Hill-Sachs lesion and a concomitant arthroscopic anterior Bankart repair. Forty-five patients (76%) were available for follow-up ranging from 2 to 10 years (average, 58 months). All patients were evaluated by use of the Rowe and Constant scores. Twenty-seven patients were also evaluated by use of the Western Ontario Shoulder Instability Index. Of the 45 patients, 2 (4.4%) had recurrent instability after traumatic dislocations; one was due to a basketball injury, and the other was reinjured by wrestling. At final follow-up, the median and mean scores ± standard deviation were as follows: Rowe score, 95, 92 ± 12; Constant score, 95, 92 ± 10; and Western Ontario Shoulder Instability Index, 110, 224 ± 261. All patients, except the traumatic dislocations, had no reoperations or complications. This procedure provides an effective arthroscopic approach in those cases of anterior shoulder instability that present with the combination of glenoid bone loss (grade IIIA) and a Hill-Sachs lesion. Level IV, case series, treatment study.