Arthroscopic Bankart Repair Combined with Remplissage Technique for the Treatment of Anterior Shoulder Instability with Engaging Hill-Sachs Lesion

American Journal of Sports Medicine - Tập 39 Số 8 - Trang 1640-1648 - 2011
Yiming Zhu1,2, Yi Lu1,2, Jin Zhang1,2, Jie-wei Shen1,2, Chunyan Jiang3,1,2
1Investigation performed at Beijing Ji Shui Tan Hospital, Beijing, People's Republic of China
2Sports Medicine Department, Beijing Ji Shui Tan Hospital, Beijing, People's Republic of China.
3Address correspondence to Chun-Yan Jiang, MD, PhD, Professor, Sports Medicine Department, Beijing Ji Shui Tan Hospital, No 31 Xinjie-koudongjie, 100035 Beijing, P. R. China (e-mail: ).

Tóm tắt

BackgroundEngaging Hill-Sachs lesions are known to be a risk factor for recurrence dislocation after arthroscopic repair in patients with anterior shoulder instability. For a large engaging Hill-Sachs lesion, arthroscopic remplissage is a solution.HypothesisArthroscopic Bankart repair combined with the Hill-Sachs remplissage technique can achieve good results without significant impairment of shoulder function.Study DesignCase Series; Level of evidence, 4.MethodsForty-nine consecutive patients who underwent arthroscopic Bankart repair and Hill-Sachs remplissage for anterior shoulder instability were followed up for a mean duration of 29.0 months (range, 24-35 months). There were 42 males and 7 females with a mean age of 28.4 years (range, 16.7-54.7 years). All patients had diagnosed traumatic unidirectional anterior shoulder instability with a bony lesion of glenoid and an engaging Hill-Sachs lesion. Physical examination, radiographs, and magnetic resonance imaging were performed during postoperative follow-up. The American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Rowe score were used to evaluate shoulder function.ResultsThe active forward elevation increased a mean of 8.0° (range, -10° to 80°) postoperatively. However, the patients lost 1.9° (range, -40° to 30°) of external rotation to the side. Significant improvement was detected with regard to the ASES score (84.7 vs 96.0, P < .001), Constant score (93.3 vs 97.8, P = .005), and Rowe score (36.8 vs 89.8, P < .001). There were 1 redislocation, 2 subluxations, and 1 patient with a positive apprehension test; the overall failure rate was 8.2% (4 of 49). Successful healing of the infraspinatus tendon within the Hill-Sachs lesion was shown by magnetic resonance imaging.ConclusionArthroscopic Bankart repair combined with Hill-Sachs remplissage can restore shoulder stability without significant impairment of shoulder function in patients with engaging Hill-Sachs lesions.

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American Journal of Sports Medicine

Tập 39 Số 8

1640-1648

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