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Treatment for patients with anterior glenohumeral instability with subcritical bone loss is evolving. The purpose of this study was to compare 2-year outcomes of arthroscopic Bankart repair with and without Hill-Sachs remplissage in patients with15% glenoid bone loss.A multicenter retrospective study was performed on a consecutive series of patients who underwent primary isolated arthroscopic Bankart repair (IBR) or arthroscopic Bankart repair with remplissage (REMP) by 4 shoulder specialists between 2013 and 2019. Range of motion (ROM) and patient-reported outcomes (PROs) were collected at baseline and 2 years postoperative: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Recurrence, return to sport, satisfaction, complications, and revisions also were reviewed.A total of 123 patients were available, including 75 IBR and 48 REMP. Baseline demographics, activity, ROM, and PROs were similar. Mean glenoid bone loss (2.5% vs 6.1%:Despite slightly worse pathology, patients with subcritical bone loss who undergo REMP experience similar short-term postoperative function to isolated IBR. Recurrence, revision, and return to sport favored REMP but this study was underpowered to show statistical significance. Recurrence was common following IBR, despite subcritical glenoid bone loss and primarily on-track lesions, suggesting that REMP can be considered in on-track lesions.III, retrospective comparative study.

Resume Introduction Le but de cette etude est d’analyser la faisabilite d’un split passif du sous-scapulaire par rotation du bras lors d’une stabilisation anterieure dynamique (DAS pour « Dynamic anterior stabilization ») et d’analyser le nouveau cheminement du long chef du biceps brachial (LCB). Hypothese L’hypothese est que cette technique simple passive peut creer un split du sous-scapulaire sans discision supplementaire donnant lieu a une nouvelle position du LCB avec une fonction stabilisante. Materiel et methodes Une technique de split du sous-scapulaire utilisant le LCB a ete utilisee dans 12 epaules cadaveriques humaines fraichement congelees. Un split du sous-scapulaire est cree par rotation passive du bras apres que le LCB ait ete transporte dans l’articulation glenohumerale durant une DAS. La longueur du split du sous-scapulaire, la longueur du LCB et l’angulation du LCB par rapport a la gouttiere bicipitale ont ete mesurees pour evaluer si cette nouvelle geometrie peut donner un nouvel effet stabilisateur au sous-scapulaire. Resultats La longueur moyenne du split du sous-scapulaire apres rotation maximale est de 20,4 ± 6,0 mm (extremes de 10 a 32 mm). L’allongement moyen du LCB est de 0,6 ± 1,4 mm (extremes de −1 a +3 mm). L’angle final du LCB par rapport a la gouttiere bicipitale est de 45 ± 5 degres (extremes de 41 a 55 degres). Discussion Il n’est pas necessaire de creer activement un split lors d’une DAS. La DAS maintient la relation longueur–tension du LCB. L’angulation postoperatoire du LCB par rapport a la gouttiere bicipitale peut fournir un abaissement du sous-scapulaire, aidant a expliquer le renfort anterieur de cette technique. Niveau de preuve Recherche fondamentale, etude cadaverique.

Background: Surgical management of anterior shoulder instability continues to evolve. The clinical effectiveness of arthroscopic Bankart repair with remplissage (REMP) in patients with increasing glenoid bone loss (GBL) has not been thoroughly compared with Latarjet. Purpose/Hypothesis: The purpose of this study was to compare 2-year outcomes of REMP versus open Latarjet in patients with >15% GBL. We hypothesized that there would be no difference. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter, retrospective study was performed on a consecutive series of patients who underwent primary REMP or Latarjet by 4 shoulder specialists between August 2013 and December 2019 for >15% GBL. Procedure performance was based on shared decision making between the surgeon and patient. Baseline and 2-year postoperative range of motion (ROM) and the following patient-reported outcomes (PROs) were collected: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Return to sport, satisfaction, complications, recurrence, and revisions were reviewed. Results: A total of 47 patients were available for study, including 22 who underwent REMP and 25 who underwent Latarjet. Baseline demographic characteristics, ROM, and PROs were similar between the groups. Mean preoperative GBL (REMP 25.8% ± 7.8% vs Latarjet 25.1% ± 9.0%; P = .800) and off-track lesions (REMP 59.1% vs Latarjet 44.0%; P = .302) were similar. Postoperative change in external rotation favored Latarjet (10° ± 22° vs –4° ± 13°; P = .017). Postoperative PROs, return to the sports (86.4% vs 87.5%; P = .99), and satisfaction (95.5% vs 95.8%; P = .99) were similar between groups. There were no recurrent dislocations in either group. One infected hematoma was encountered in the Latarjet cohort. Conclusion: At short-term follow-up, the hypothesis was upheld. REMP and Latarjet provided similar outcomes for patients with >15% GBL, although REMP patients experienced slightly decreased external rotation. Although larger series and longer-term follow-ups are required, remplissage may be considered in patients with >15% glenoid bone loss.

Objective The purpose of this study was to prospectively evaluate the functional outcome and complications of unstable acromioclavicular (AC) joint separations repaired with a single coracoclavicular tunnel utilizing an arthroscopic-assisted curved button technique. Methods Thirty-five patients with a minimum of 12 months follow-up underwent arthroscopic-assisted AC joint reconstruction with suspensory button and 2 mm suture tape fixation using 3 mm tunnels. Functional outcome scores were analyzed preoperatively and at final follow-up with all complications noted. Results Comparing preoperative to postoperative values, all functional outcome scores improved. Three of the 16 (19%) patients that had a supplementary graft looped around the undersurface of the coracoid demonstrated loss of reduction compared to eight of the 19 (42%) that were treated with button and suture fixation alone (p = .138). No loss of reduction occurred in the subset of patients with AC joint supplementation. One (3%) patient sustained a distal clavicle fracture. Conclusion Arthroscopic-assisted AC joint reconstruction with a suspensory button construct demonstrates improved clinical outcomes with high patient satisfaction. While loss reduction remains problematic, smaller bone tunnels appear to lead to a low rate of iatrogenic fractures. The addition of a free tendon graft, as well as AC cerclage, appears to minimize loss of reduction.

Introduction The purpose of the present study was to analyze the ability to create a subscapularis split by passive rotation of the arm during dynamic anterior stabilization (DAS) and to analyze the new geometry of the long head of the biceps LHB. Hypothesis The hypothesis was that this passive simple technique can create subscapularis split without additional dissection giving rise to new position of LHB with a new stabilization function. Material and methods A technique of subscapularis split using the LHB was used in 12 fresh-frozen human cadaveric shoulders. A subscapularis split was created by passive rotation of the arm after the LHB is shuttled into the joint during DAS. The length of the subscapularis split, post-DAS position and length of the LHB, and the angulation of the LHB relative to bicipital groove were measured after DAS and if this new geometry can give a new dynamic effect on subscapularis muscle. Results The mean length of the subscapular split after maximal rotation was 20.4 ± 6.0 mm (range: 10–32 mm). The mean elongation of the LHB was 0.6 ± 1.4 mm (range: −1 to +3 mm). The final angle of the LHB relative to the bicipital groove was 45 ± 5 degrees (range: 41 to 55 degrees). Discussion There is no need to create a distinct split prior to DAS. Additionally, DAS maintains the length-tension relationship of the LHB. The post-procedure medial angulation of the LHB relative to the bicipital groove may provide a lowering of the subscapularis, helping explain the anterior reinforcement of this technique. Level of evidence Basic science study, cadaver study.

Arthroscopic remplissage of a Hill–Sachs lesion is classically described as a capsulotenodesis of the infraspinatus within the posterolateral humeral head. The aim of this cadaveric study was to evaluate the anatomic relationship between the position of anchors and sutures placed for remplissage and the infraspinatus and teres minor. The hypothesis was that remplissage actually corresponds to a capsulomyodesis of the infraspinatus and teres minor muscles. A two-anchor arthroscopic remplissage was performed followed by open dissection of ten fresh-frozen human cadaveric shoulders. The exit point of sutures related to muscle–tendon unit as well as the distance between the anchors and the rotator cuff was measured. The superior sutures were localized generally in the infraspinatus, near the musculotendinous junction. The inferior sutures passed through the teres minor muscle in seven of ten cases. The distance between the superior and inferior anchors and the posterolateral greater tuberosity was 14 ± 2 and 12 ± 3 mm, respectively. Arthroscopic remplissage is a capsulomyodesis of infraspinatus and teres minor rather than a capsulotenodesis of the infraspinatus alone as previously believed. Muscular damage may explain posterosuperior pain observed in patients who underwent remplissage.