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Modified arthroscopic remplissage for Hill-Sachs lesions with high-strength sutures

Modifizierte arthroskopische Remplissage mit hochverstärktem Nahtmaterial bei Hill-Sachs-Läsion

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Abstract

Objective

The aim is to present a modified arthroscopic remplissage for shoulder Hill-Sachs lesions with high-strength sutures instead of suture anchors, to achieve better tendon–bone healing and avoid failure of remplissage due to anchor detachment.

Material and methods

A total of seven patients with recurrent anterior shoulder dislocation combined with a Hill-Sachs lesion were included in this study. Firstly, anteroinferior glenoid labrum complex damage was treated then 2–3 bone tunnels were punched with a sighting device from the bony defect of the humeral head to the inside of lesser tubercles of the humerus. The bony defect was filled by stitching the infraspinatus tendon through the bony tunnels with high-strength sutures. After the operation, the filling and healing of the infraspinatus tendon in the Hill-Sachs lesion were assessed using magnetic resonance imaging (MRI).

Results

Patients were followed up for 12 months. The results of MRI showed that all of the filled tendons healed well. Postoperative external rotation of the shoulder joint increased on average from 67° to 87°. Compared with the preoperative level, the Oxford Shoulder Instability Score (OSIS) was 18.50 ± 1.04 points higher and the Rowe score was increased by 66.755 ± 0.914 points.

Conclusion

Arthroscopic remplissage of a shoulder Hill-Sachs lesion with high-strength sutures carries the benefits of secure fixing and good tendon–bone healing without the risk of anchor detachment.

Zusammenfassung

Ziel

Ziel dieses Beitrags ist es, eine modifizierte arthroskopische Remplissage bei einer Hill-Sachs-Läsion mit hochverstärktem Nahtmaterial anstelle von Fadenankern vorzustellen, um eine bessere Sehnen-Knochen-Heilung zu erreichen und ein Versagen der Remplissage durch eine Ankerablösung zu vermeiden.

Material und Methoden

Insgesamt 7 Patienten mit rezidivierender anteriorer Schulterluxation kombiniert mit einer Hill-Sachs-Läsion wurden in diese Studie eingeschlossen. Zunächst wurde das geschädigte anteroinferiore Labrum glenoidale behandelt, dann wurden unter Bildwandlerkontrolle 2–3 Knochentunnel vom Knochendefekt des Humeruskopfes zur Innenseite der kleineren Tuberkel des Humerus gebohrt. Der Knochendefekt wurde gefüllt, indem die Infraspinatussehne mit hochverstärktem Fadenmaterial in den Knochentunneln vernäht wurde. Nach der Operation wurde die Einheilung der Infraspinatussehne in die Hill-Sachs-Läsion mittels Magnetresonanztomographie (MRT) beurteilt.

Ergebnisse

Die Patienten wurden für 12 Monate nachuntersucht. Die Ergebnisse der MRT zeigten, dass alle gefüllten Sehnen gut geheilt waren. Die postoperative externe Rotation des Schultergelenks stieg im Durchschnitt von 67° auf 87°. Verglichen mit den präoperativen Werten, war der Oxford Shoulder Instability Score (OSIS) mit 18,50 ± 1,04 Punkten höher und der Rowe-Score stieg um 66,755 ± 0,914 Punkte.

Schlussfolgerung

Die arthroskopische Remplissage einer Hill-Sachs-Läsion der Schulter mit hochverstärktem Fadenmaterial bringt den Vorteil einer sicheren Fixierung und guten Sehen-Knochen-Heilung ohne das Risiko einer Ankerablösung.

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Abbreviations

ACL:

Anterior cruciate ligament

MRI:

Magnetic resonance imaging

OSIS:

Oxford shoulder instability score

SLAP:

Superior labrum anterior and posterior

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Authors and Affiliations

  1. Department of Orthopedics, Shandong Qianfoshan Hospital, Shandong University, 16766 Jing Shi Road, 250014, Jinan, Shandong Province, China

    Yeteng He, Xianbo Peng, Zhen Yuan, Jianli Zhao, Qian Yu & Xinfeng Yan

Authors
  1. Yeteng He
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  2. Xianbo Peng
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  3. Zhen Yuan
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  4. Jianli Zhao
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  5. Qian Yu
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  6. Xinfeng Yan
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Corresponding author

Correspondence to Xinfeng Yan.

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Conflict of interest

Y. He, X. Peng, Z. Yuan, J. Zhao, Q. Yu and X. Yan declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

Yeteng He und Xianbo Peng share the first authorship and have made equal contributions to the article.

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He, Y., Peng, X., Yuan, Z. et al. Modified arthroscopic remplissage for Hill-Sachs lesions with high-strength sutures. Orthopäde 49, 260–266 (2020). https://doi.org/10.1007/s00132-019-03751-4

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  • DOI: https://doi.org/10.1007/s00132-019-03751-4

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