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Arthroscopic Anterior Labral Repair with Remplissage

March 15, 2015

Contributors: Eric Jason Strauss, MD, FAAOS; Guillem Gonzalez-Lomas, MD; Maxwell Weinberg, MD; William Ryan, BS; Dylan Lowe, MD; Laith M Jazrawi, MD, FAAOS; Laith M Jazrawi, MD, FAAOS

BACKGROUND: The highest rate of incidence for dislocation in a major joint is seen in the shoulder. The rate of recurrent dislocation is particularly high especially in younger patients. Incidence rates for both initial and recurrent dislocations are higher in patients who are male, athletes, or under 30 years old. Large engaging Hill-Sachs lesions with glenoid bone loss are positively associated with continued glenohumeral dislocation and pose unique surgical issues. Isolated arthroscopic labral repairs have been largely unsuccessful in this patient population. The Remplissage technique was developed to address glenohumeral instability that was unresponsive to isolated arthroscopic repair. The purpose of this video is to demonstrate the Remplissage procedure in order to optimally treat patients with significant humeral head defects.

METHODS: A variety of operative techniques are available for recurrent instability of the glenohumeral joint depending on the nature and severity of the injury. This video illustrates an arthroscopic anterior labral repair with Remplissage for a patient with 20% bone loss from the humeral head. Relevant patient history and anatomy, injury presentation and workup, nonoperative management, surgical indications, pre and postoperative imaging, postoperative rehabilitation, and clinical outcomes also are reviewed. The important steps and rationale behind the procedure are highlighted.

RESULTS: The video presents one case of recurrent glenohumeral instability managed suing the Remplissage procedure. Following successful Remplissage procedure using two singly loaded 4.5 mm anchors, the arm was successfully taken through full range of motion. Glenohumeral stability was restored in this patient, and the current literature supports this finding.

CONCLUSIONS: The Remplissage procedure represents an effective and safe option for treating recurrent anterior glenohumeral instability due to large bony deficiency of the humeral head. This video illustrates an arthroscopic anterior labral repair combined with a Remplissage procedure to correct the Hill-Sachs lesion and render the defect extra-articular. This technique demonstrates consistently successful outcomes when indicated.

Results for "Shoulder: Instability"

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