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ARTHROSCOPIC “HILL-SACHS REMPLISSAGE”: DOES THE CAPSULE AND INFRASPIINATUS TENDON HEAL IN THE HUMERAL BONE DEFECT?

Authors: P Vargas; M Pinedo; J Old; M Zumstein; P Boileau

References: Presented at SECEC 2009

Purpose
The "Hill-Sachs Remplissage "(HSR) consists of an arthoscopic posterior capsulodesis and infraspinatus tenodesis within the Hill-Sachs lesion. There is no proof nowadays that the capsule and tendon heal in the bone defect. Our hypothesis is that the capsulotenodesis heals in the Hill-Sachs lesion and covers the defect at least 50% of its area.

Material and Methods
Prospective clinical study. Inclusion criteria : 1) anterior instability (dislocation or subluxation) ; 2) engaging Hill-Sachs lesion. Exclusion criteria : 1) glenoid bone loss ; 2) rotator cuff tear. Twenty patients underwent an arthroscopic Bankart repair plus HSR. Either a CT arthrogram (19 patients) or MRI (1 patient) was performed at a minimum of six months postoperatively. Four orthopaedic surgeons analyzed the images independently to determine the percentage of healing of the capsulotenodesis.

Results
There was healing of the capsulotenodesis within the bone defect in all twenty patients. The covered bone defect was greater than 75% in sixteen of the twenty patients (80%). The remaining four had a bone defect coverage between 50 and 75%. There was no defect coverage of less than 50% in this study.

Conclusion
This study shows that the posterior capsulotenodesis heals in all patients alter an arthroscopic "Hill-Sachs Remplissage ". The bone defect coverage was nearly complete in most of the cases. Longer term Studies are necessary to estbalish whether there is an association between the rate of healing and clinical outcomes.

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