Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique
Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique
复制标题
关节镜 Hill-Sachs Remplissage 与 Bankart 修复：策略与技术
DOI：
10.2106/jbjs.st.m.00033
复制
发表时间：
2014
影响因子：
1.3
通讯作者：
M. Zumstein
中科院分区：
文献类型：
--
作者：
P. Boileau;Walter B. McClelland;K. O'Shea;P. Vargas;Miguel Pinedo;Jason Old;M. Zumstein
Introduction
Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability.
Step 1 Anterior Capsulolabral Mobilization and Glenoid Preparation
Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect.
Step 2 Preparation of the Hill-Sachs Defect
With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus.
Step 3 Remplissage with the Posterior Aspect of the Capsule and Infraspinatus Tendon
Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm).
Step 4 Anterior Bankart Repair
Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair.
Step 5 Postoperative Rehabilitation Protocol
Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months.
Results
In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.IndicationsContraindicationsPitfalls & Challenges.
