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Bankart repair with remplissage restores better shoulder stability than Bankart repair alone, and medial or two remplissage anchors increase stability but decrease range of motion: a finite element analysis

  • Author Footnotes
    # Feng.S and Li.H contributed equally to this work.
    Sijia Feng
    Footnotes
    # Feng.S and Li.H contributed equally to this work.
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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  • Author Footnotes
    # Feng.S and Li.H contributed equally to this work.
    Huizhu Li
    Footnotes
    # Feng.S and Li.H contributed equally to this work.
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    Search for articles by this author
  • Yuzhou Chen
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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  • Jun Chen
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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  • Xiaoxi Ji
    Correspondence
    Corresponding author: Xiaoxi Ji, Telephone number: +86 21 52888255, Postal address: No.12 Wulumuqi Zhong Road, Shanghai, China, 200040
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    Search for articles by this author
  • Shiyi Chen
    Correspondence
    Corresponding author: Shiyi Chen Email address: , Telephone number: +86 21 52888255, Postal address: No.12 Wulumuqi Zhong Road, Shanghai, China, 200040
    Affiliations
    Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    Search for articles by this author
  • Author Footnotes
    # Feng.S and Li.H contributed equally to this work.

      Abstract

      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 four models of Bankart repair with remplissage based on different remplissage anchor numbers and positions. 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 two anchors were used. and was minimized in the combined repair model with two 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 two medially placed anchors showed the largest slope on the force-displacement curve, indicating the largest strain on the humeral head.

      Conclusion

      Based on a finite element analysis, Bankart repair with remplissage restored better shoulder stability compared to 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 two anchors were used, the stability of the glenohumeral joint increased but with a loss of range of motion.

      Key words

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