Pushpasekaran Narendran, Rajkumar Rajaram Rajuthevar, Sundaram Kandasamy Meenakshi, Sivanandan Muthukannan Hari
Department of Orthopaedics, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, India.
Arthrosc Tech. 2025 May 22;14(7):103643. doi: 10.1016/j.eats.2025.103643. eCollection 2025 Jul.
Arthroscopic remplissage repair of the Hill-Sachs defect has been advocated for engaging or off-track presentation in recurrent shoulder instability. The various described techniques use specialized instruments to pass sutures across the tendon or deploy multiple anchors directly through the infraspinatus tendon and capsule to avoid suture-passing instruments. With either of these methods, pitfalls include a larger-than-required rent in the tissue compromising the tendon quality, along with technical challenges of placing the anchors, deltoid entrapment, the need for accessory portals, and the risk of suture off-loading compromising the repair. In our technique, by viewing from the anterosuperior portal, the sutures from the Hill-Sachs anchor are passed through the infraspinatus tendon by a percutaneously placed spinal needle outside the posterior portal. Finally, all the passed threads are retrieved outside the infraspinatus tendon and capsule in the subacromial space through the posterior portal using an arthroscopic shoulder retriever, thereby avoiding accessory portals and allowing the placement of knots without deltoid entrapment. The percutaneous access allows a better trajectory and precise penetration of the infraspinatus tendon and posterior capsule without creating a rent. This technique is safe, replicable, and cost-effective by avoiding the risk of suture off-loading from the anchor and the need for additional anchors and devices.
关节镜下填充修复Hill-Sachs损伤已被推荐用于复发性肩关节不稳的嵌顿或脱轨表现。各种已描述的技术使用专门器械使缝线穿过肌腱，或直接通过冈下肌腱和关节囊置入多个锚钉，以避免使用缝线穿过器械。采用这两种方法中的任何一种，都存在一些缺陷，包括组织中出现大于所需的撕裂口，影响肌腱质量，以及放置锚钉的技术挑战、三角肌卡压、需要辅助切口，还有缝线卸载风险影响修复效果。在我们的技术中，通过前上切口观察，Hill-Sachs锚钉的缝线由后切口外侧经皮置入的脊椎穿刺针穿过冈下肌腱。最后，使用关节镜下肩部牵开器，通过后切口将所有穿过的线在肩峰下间隙从冈下肌腱和关节囊外取出，从而避免辅助切口，并允许在不发生三角肌卡压的情况下打结。经皮入路可实现更好的进针轨迹，精确穿透冈下肌腱和后关节囊，而不会造成撕裂口。该技术安全、可重复且具有成本效益，可避免缝线从锚钉上卸载的风险以及对额外锚钉和器械的需求。
