The Hill-Sachs defect is a compression fracture of the posterolateral humeral head that is associated with anterior shoulder dislocation or recurrent instability. Large lesions with advanced bone loss are more likely to engage, resulting in shoulder instability at lower arm abduction angles, and if left untreated at time of soft tissue labral repair, a higher failure rate and recurrent instability will occur.
A recent arthroscopic management of these defects includes transfer of the infraspinatus and posterior capsule into the defect, known as the remplissage procedure. In the present study we describe the clinical results of this procedure performed on 20 patients from 2016 to 2018 with complete follow up for one year. At the final follow up, patients were assessed regarding the range of motion (ROM), the Simple Shoulder Test (SST) and the Rowe score of shoulder instability (ROWE) as compared to both the pre-operative status of the affected side, and also to the functional status of the normal side.
When compared to pre-operative ROM, a statistically significant difference was found in the mean increase of anterior elevation by 2◦, external rotation (ER) side by 4◦ and 5° for ER at 90° abduction at final follow-up (p value < 0.001). There was statistically significant difference in the mean decrease of 5◦ and 10◦ in ER side and ER at 90◦ abduction respectively at final follow-up compared to normal side ROM (p value < 0.001), also significant decrease in anterior elevation by 4◦ and IR at 90◦ abduction by 2◦ (p value < 0.001) which were not comparable to other studies but was clinically insignificant. The mean final Rowe and SST scores were 85 and 11.35 respectively indicating a statistically significant difference in mean increase of both the total Rowe and total SST percentage score when compared to pre-operative scores (p value < 0.001).
Our study revealed satisfactory clinical subjective and objective results at one-year follow-up. There were no significant complications. In particular, the concern that the remplissage would limit rotation was of little value. The slight restriction in external rotation (approximately 10°) does not significantly affect patient’s life. This is an effective approach to a difficult subgroup of instability patients with a significant potential for failure of an isolated standard arthroscopic Bankart repair.
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