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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; David Kovacevic, MD; David Kovacevic, MD

INTRODUCTION: Shoulder instability with bipolar bone loss is a treatment challenge. Factors such as patient age, participation in collision sports, glenoid bone loss, as well as size of the Hill-Sachs lesion influence surgical decision making. Remplissage is a concomitant technique to Bankart repair to fill a Hill-Sachs defect and address shoulder instability. This video presents a bony Bankart bridge repair combined with remplissage for the treatment of complex shoulder instability.

METHODS: Performing a double-row bony Bankart repair is advantageous as it provides compression and rotational stability by way of two-point fixation compared to single point fixation techniques. Remplissage, when used in combination with bony Bankart bridge repair, can be used to provide secure initial fixation during the healing phase to address engaging Hill-Sachs lesions and glenoid defects up to 25%, respectively.

RESULTS: We demonstrate the technique for bony Bankart bridge repair with concomitant remplissage in a case of acute, traumatic complex shoulder instability with an engaging posterolateral humeral head compression fracture in a highly active patient. The senior author has utilized this surgical technique in six patients, with all regaining full shoulder motion, return to work or sport by six months, and no recurrent instability events. The pertinent aspects of the technique are highlighted and the rationale behind the approach is reviewed.

DISCUSSION AND CONCLUSION: An all-arthroscopic technique to address bone defects involving both the glenoid and humeral head is not only appealing, but may be preferred by surgeons wanting to avoid the complications associated with open bone block procedures. Currently, there is a paucity of high level evidence comparing arthroscopic and open techniques for the surgical management of complex shoulder instability. The procedure described in this video is reproducible and makes use of two-point fixation and soft tissue tenodesis principles to create a stable fixation construct that restores glenoid bone anatomy and prevents Hill-Sachs engagement for highly active patients with complex shoulder instability.

Results for "Shoulder Preservation"

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