Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair.

Purpose: Treatment for patients with anterior glenohumeral instability with subcritical bone loss is evolving. The purpose of this study was to compare 2-year outcomes of arthroscopic Bankart repair with and without Hill-Sachs remplissage in patients with <15% glenoid bone loss. Methods: A multicenter retrospective study was performed on a consecutive series of patients who underwent primary isolated arthroscopic Bankart repair (IBR) or arthroscopic Bankart repair with remplissage (REMP) by 4 shoulder specialists between 2013 and 2019. Range of motion (ROM) and patient-reported outcomes (PROs) were collected at baseline and 2 years postoperative: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Recurrence, return to sport, satisfaction, complications, and revisions also were reviewed. Results: A total of 123 patients were available, including 75 IBR and 48 REMP. Baseline demographics, activity, ROM, and PROs were similar. Mean glenoid bone loss (2.5% vs 6.1%: P < .001) was greater in REMP, although the number of on-track lesions was similar (98.7% vs 93.8%: P = .298). WOSI scores were improved for REMP (196.5 vs 42.7: P = .004), but otherwise no difference in postoperative PROs or ROM. Differences between cohorts did not reach significance in return to sport (73% vs 83%: P = .203), recurrence (9.3% vs 2.1%: P = .148), or revisions (6.8% vs 2.1%: P = .403). For on-track lesions there were 6 recurrences in IBR (6 of 74; 8.1%) and 1 recurrence in REMP (1 of 45; 2.2%). Conclusions: Despite slightly worse pathology, patients with subcritical bone loss who undergo REMP experience similar short-term postoperative function to isolated IBR. Recurrence, revision, and return to sport favored REMP but this study was underpowered to show statistical significance. Recurrence was common following IBR, despite subcritical glenoid bone loss and primarily on-track lesions, suggesting that REMP can be considered in on-track lesions. Level of Evidence: III, retrospective comparative study.

The Addition of Remplissage to Free Bone Block Restores Translation and Stiffness Compared to Bone Block Alone or Latarjet in a Bipolar Bone Loss Model.

PURPOSE: The purpose of this study was to compare glenohumeral stability following a Latarjet, a free bone block (FBB), and a FBB with remplissage for bipolar bone loss. METHODS: Nine matched pairs of fresh frozen cadavers were tested in a custom biomechanical apparatus with rotation and progressive translational loading. The free bone block group consisted of a distal tibial allograft with an all-suture tape construct. The Latarjet group was performed with the native coracoid and two partially threaded cannulated screws. A bipolar bone loss model was created with 20% glenoid bone loss and an off-track Hill-Sachs lesion. Testing conditions included the 1) native state, 2) bipolar bone loss model, 3) Latarjet, 4) FBB with distal tibial allograft secured with cerclage sutures, and 5) FBB with remplissage. Each condition was tested for translation, humeral head apex shift, stiffness, and dislocation force. RESULTS: There were no differences in translation, stiffness, or dislocation forced between the FBB alone and Latarjet groups. The FBB with remplissage group demonstrated the lowest anterior-inferior translation at 90° of ER, which was statistically significant compared to Latarjet 20N (P = .013) and compared to the FBB alone at 40N (P = .024) and 50N (P = .011). The FBB with remplissage group was significantly stiffer compared to FBB alone at 90° ER with approximately 60% change in stiffness (P = .028). The force required to dislocate the humeral head after treatment was highest in the FBB with remplissage group, which was statistically significant compared to the FBB alone (P = .003) and Latarjet groups (P = .018). CONCLUSION: The addition of remplissage to a FBB restores translation and stiffness closer to the intact state compared to a FBB alone or Latarjet in a bipolar bone loss model with an off-track Hill-Sachs lesion. In this model, dislocation force significantly increased with the addition of remplissage to the FBB. CLINICAL RELEVANCE: This biomechanical study provides evidence that Latarjet and FBB are both acceptable forms of treatment for bipolar bone loss, but stability can be enhanced with the addition of remplissage following glenoid reconstruction.

Semitendinosus Allograft Cable Reconstruction Technique for Massive Irreparable Rotator Cuff Tears.

Massive irreparable rotator cuff tears are difficult to treat. Disruption of the rotator cable and joint capsule leads to altered glenohumeral joint mechanics, superior migration of the humeral head, and limited overhead function. A few graft options exist for reconstruction, with limited outcomes data. A newer technique using a hamstring allograft provides benefits compared with other graft reconstruction options. This Technical Note describes a rotator cable reconstruction using a V-shaped hamstring allograft for treatment of a massive, irreparable rotator cuff tear.

All-Inside Knotless Remplissage Technique.

Remplissage decreases the risk of recurrence after arthroscopic stabilization for recurrent anterior instability. Traditionally, the procedure requires accessing the subacromial space, which adds time and morbidity to the procedure. This Technical Note describes an all-inside technique for knotless remplissage with 2 interconnected anchors. By avoiding knot tying or accessing the subacromial space, the efficiency of the procedure is improved.