Dataset Information

Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions.

ABSTRACT: Hill-Sachs lesions are a common finding in patients with glenohumeral instability. There have been numerous methods described for addressing Hill-Sachs deformity. One popular method includes transferring a portion of the infraspinatus muscle into the posterior-superior defect (remplissage) to prevent the lesion from engaging and the resultant instability. We present a method of arthroscopic remplissage whereby the lesion is addressed through transtendinous insertion of arthroscopic anchors. Once 2 anchors have been inserted, 1 limb of each suture is tied to the other anchor, the so-called pulley repair technique. This can be performed either under direct visualization in the subacromial space or blindly while the surgeon is viewing from the articular side. Once both limbs have been tied, the infraspinatus tendon nicely spans the defect, and there has been minimal morbidity to the tendon itself. We have found this method to be useful for addressing a large Hill-Sachs deformity.

SUBMITTER: Parnes N

PROVIDER: S-EPMC4680851 | biostudies-other | 2015 Aug

REPOSITORIES: biostudies-other

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Publications

Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions.

Parnes Nata N Carey Paul A PA Schumacher Christopher C Price Mark D MD

Arthroscopy techniques 20150713 4

Hill-Sachs lesions are a common finding in patients with glenohumeral instability. There have been numerous methods described for addressing Hill-Sachs deformity. One popular method includes transferring a portion of the infraspinatus muscle into the posterior-superior defect (remplissage) to prevent the lesion from engaging and the resultant instability. We present a method of arthroscopic remplissage whereby the lesion is addressed through transtendinous insertion of arthroscopic anchors. Once ...[more]

PMID: 26759767

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Project description:Glenohumeral instability causing bipolar bone loss is increasingly being recognized and treated to minimize recurrence. Large Hill–Sachs and reverse Hill–Sachs lesions of the humerus must be addressed at the time of surgery to prevent recurrent dislocations and restore the native anatomic track. For patients with epilepsy, locked dislocations may create defects that must be addressed with bony procedures, including osteochondral allograft reconstruction as soft-tissue remplissage may not adequately addresses the magnitude of the bone loss. Osteochondral allografts have been successfully used to address bony defects ranging from 20% to 30% of humeral bone loss whereas shoulder arthroplasty is indicated for larger defects where the native anatomy can no longer be restored. In this Technical Note, we present a technique to address concomitant large Hill–Sachs and reverse Hill–Sachs lesions. Technique Video Video 1 The patient in this case example has a large Hill–Sachs and reverse Hill–Sachs lesion of the left humeral head. A standard deltopectoral approach is performed. The subscapularis tendon is released via a subscapularis peel directly off of its insertion on the lesser tuberosity directly medial to the long head of the biceps tendon. Adequate release of the inferior capsule is performed to be able to access the humeral head lesions with extension and maximal external rotation. The lesions on the humeral head are prepared into flat surfaces with a sagittal saw. Bone wax is used to fill each defect to recreate native anatomy. The bone wax is used as a template to harvest the same size wedge from the proximal humeral osteochondral allograft on the back table. Two allograft wedges are harvested; one for the Hill–Sachs lesion and the other for the reverse Hill–Sachs lesion. The allograft wedges are fixed into each lesion with 3.5 mm cannulated headless compression screws (Acumed Acutrak headless compression screw system; Hillsboro, OR). The subscapularis is repaired via transosseous suture repair.

Dataset Information

Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions.

Publications

Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions.

Similar Datasets

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