Ashy Cody, Pottanat Paul, Slone Harris, Pullen W Michael
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina, USA.
Video J Sports Med. 2024 Apr 18;4(2):26350254231216476. doi: 10.1177/26350254231216476. eCollection 2024 Mar-Apr.
Anterior shoulder instability is associated with Hill-Sachs lesions (HSLs) in 40% to 90% of cases. When addressing anterior shoulder instability, unaddressed engaging or "off-track" HSL have a recurrence rate of 75%. Remplissage is a known technique to address recurrent instability in the setting of an engaging HSL. In this video, we demonstrate that a double-anchor-pulley technique may be used to address recurrent instability in the setting of engaging HSL.
Patients with recurrent anterior shoulder instability with off-track HSL in patients with glenoid bone loss <20% are candidates for arthroscopic Remplissage.
Patients are placed in the lateral decubitus position. Examination under anesthesia is performed to assess for degree of instability and engagement of HSL. Posterior, anterosuperior, and anteroinferior portals are established. Routine diagnostic arthroscopy is performed with identification of the HSL. While viewing from an anterosuperior portal and working through the posterior portal, the HSL bed is prepared with curettage and a bur. A 5.5-mm accessory Cannula is used through an accessory posterior portal. Two knotless all-suture self-tensioning anchors are placed in the anterior and inferior aspect of the defect, passed through the cannula, and tagged for later identification. Bankart stabilization is performed. The knotless anchors are linked to each other to perform a knotless repair with a broad area of compression.
Results are excellent with only a 5.6% failure rate, significant patient improvement, low complication rate, and 95.5% return to play.
We demonstrate the technical aspects of an all-arthroscopic Remplissage technique using all-suture knotless anchors to provide a simple and reproducible method of performing a Remplissage.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在40%至90%的病例中，前肩不稳与希尔-萨克斯损伤（HSLs）相关。在处理前肩不稳时，未处理的嵌顿性或“脱轨”HSL的复发率为75%。关节囊填充术是一种已知的用于处理嵌顿性HSL情况下复发性不稳的技术。在本视频中，我们展示了一种双锚滑轮技术可用于处理嵌顿性HSL情况下的复发性不稳。
关节盂骨丢失<20%的复发性前肩不稳伴脱轨HSL的患者是关节镜下关节囊填充术的候选者。
患者置于侧卧位。在麻醉下进行检查以评估不稳程度和HSL的嵌顿情况。建立后方、前上方和前下方入路。进行常规诊断性关节镜检查并识别HSL。从前上方入路观察并通过后方入路操作，用刮匙和磨钻准备HSL床。通过后方辅助入路使用5.5毫米辅助套管。将两个无结全缝线自张紧锚钉置于缺损的前下方，穿过套管并标记以便后续识别。进行Bankart稳定术。将无结锚钉相互连接以进行大面积压缩的无结修复。
结果极佳，失败率仅为5.6%，患者有显著改善，并发症发生率低，95.5%的患者可恢复运动。
我们展示了一种全关节镜下关节囊填充技术的技术要点，该技术使用全缝线无结锚钉，提供了一种简单且可重复的进行关节囊填充术的方法。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
