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Bony Bankart Bridge Repair Combined With Remplissage for Complex Shoulder Instability

February 19, 2016

Contributors: Dylan Lowe, MD; Christopher S Ahmad, MD, FAAOS; David Kovacevic, MD; David Kovacevic, MD

Introduction: Shoulder instability is a challenge to manage in patients with bipolar bone loss. Factors such as patient age, participation in collision sports, glenoid bone loss, and the size of the Hill-Sachs lesion affect surgical decision making. Remplissage is technique performed in combination with Bankart repair to fill a Hill-Sachs defect and manage shoulder instability. This video demonstrates bony Bankart bridge repair in combination with remplissage for the management of complex shoulder instability. Methods: Double-row bony Bankart repair is advantageous because it affords compression and rotational stability via two-point fixation compared with single-point fixation techniques. Remplissage, if used in combination with bony Bankart bridge repair, can be used to attain secure initial fixation during the healing phase in the management of engaging Hill-Sachs lesions and glenoid defects as large as 25%. Results: This video demonstrates the technique for bony Bankart bridge repair in combination with remplissage in a highly active patient with acute, traumatic complex shoulder instability and an engaging posterolateral humeral head compression fracture. The senior author has used this surgical technique in six patients, all of whom regained full shoulder motion and returned to work or sports activity by 6 months postoperatively and all in whom no recurrent instability events occurred. The pertinent aspects of the technique are highlighted, and the rationale behind the approach is reviewed. Discussion and Conclusion: An all-arthroscopic technique to manage bone defects involving the glenoid and the humeral head is appealing and may be preferred by surgeons who wish to avoid the complications associated with open bone block procedures. Currently, a paucity of high-level evidence comparing arthroscopic and open techniques for the surgical management of complex shoulder instability is available. The procedure described in this video is reproducible and involves two-point fixation and soft-tissue tenodesis principles to create a stable fixation construct that restores glenoid bone anatomy and prevents Hill-Sachs engagement in highly active patients with complex shoulder instability.

Results for "Shoulder Preservation"

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