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Biomechanical Comparison of a Hill-Sachs Reduction Technique and Remplissage: The Potential Benefits of Anatomic Reconstruction

      Introduction

      Hill-Sachs reduction represents a potential alternative treatment method to remplissage. The purpose of this study is to biomechanically compare the stabilizing effects of a Hills-Sachs reduction technique and remplissage procedure, in a complex instability model.

      Methods

      This was a comparative cadaveric study of 6 shoulders. For the Hills-Sachs lesion, A unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface in a more anatomic fashion. Also a 15% glenoid defect was made. The Hill-Sachs lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with Quickset (Arthrex) bone cement to prevent plastic deformation. Five scenarios were tested; intact specimen, bipolar lesion, Bankart repair, Remplissage with Bankart repair and Hill-Sachs reduction technique with Bankart repair. Translation, dislocation events and range motion were recorded.

      Results

      For all 6 specimens no dislocations occurred after either Remplissage or the reduction technique. Total translation with a 40N force at 90 degrees of external rotation (ER) was 5.1 mm following remplissage and 4.4 mm following the reduction technique, in comparison to the bipolar lesion at 11.1mm (p<0.001). Similarly, with a 40N force at 90 degrees of ER, total anterior-inferior translation was 5.9mm for remplissage and 4.7 mm for the reduction technique, in comparison to the bipolar lesion at 11.6 mm (p<0.001). Average ER for the remplissage was 125.2 degrees and 128.4 degrees for the reduction technique (p=0.83).

      Conclusion

      Similar joint stability was seen following both procedures, though remplissage had 3.2-degree loss of ER in comparison. While not statistically significant, any ER loss may be clinically detrimental in overhead athletes. Overall, the reduction technique is a more anatomic alternative to the Remplissage procedure with similar ability to prevent dislocation in a biomechanical model, making it a viable treatment option for engaging Hill-Sachs lesions.