Purpose
To investigate the effects of the number and location of anchors for remplissage on
postoperative glenohumeral biomechanics.
Methods
A biomechanical study was conducted involving finite element model constructed based
on data from the intact glenohumeral joint. Seven models were established, including
a normal model, a model of Bankart lesion combined with “off-track” Hill–Sachs lesion,
a model of Bankart repair alone, and 4 models of Bankart repair with remplissage based
on different remplissage anchor numbers and locations. The effects of the number and
location of the remplissage anchors on glenohumeral stability were studied through
calculation and comparison of (1) the stress and its distribution on the joint capsule,
cartilage, labrum and anchors as well as (2) the displacement of the humeral head.
Results
Finite element analysis demonstrated that contact stress on the glenohumeral cartilage
decreased when medial or 2 anchors were used and was minimized in the combined repair
model with 2 medial anchors. The stress on remplissage anchors was greater when the
anchors were placed medially. The humeral head displacement was maximized in the combined
lesion model. The combined repair models with 2 medially placed anchors showed the
largest slope on the force–displacement curve, indicating the largest strain on the
humeral head.
Conclusions
Based on a finite element analysis, Bankart repair with remplissage restored better
shoulder stability compared with Bankart repair alone in the treatment of anterior
shoulder instability involving Bankart lesion combined with “off-track” Hill–Sachs
lesion. When the anchor for remplissage was medially placed or 2 anchors were used,
the stability of the glenohumeral joint increased but with a loss of range of motion.
Clinical Relevance
The results of this study will assist in choosing the number and location of anchors
for remplissage during shoulder stabilization surgery although with some limitations.
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Article info
Publication history
Published online: July 07, 2022
Accepted:
June 27,
2022
Received:
December 13,
2021
Footnotes
See commentary on page 2984
The authors report that they have no conflicts of interest in the authorship and publication of this article. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
