Dynamic Anterior Stabilization with Hill-Sachs Remplissage Can be Employed in Skeletally Immature Patients—Operative Technique

Abstract

Background: Numerous studies indicate that glenoid bony augmentation raises the risk of complications during and after surgery. On the other hand, repairing the labrum alone in cases with subcritical glenoid bone loss results in recurrent instability and persistent apprehension. As a result, recent advancements in shoulder instability surgery prioritize fully restoring the anterior shoulder restraint.

Operative Technique: A novel method for treating recurrent anterior shoulder instability with subcritical glenoid bone loss and off-track Hill-Sachs lesion in skeletally immature patients is suggested: the use of dynamic anterior stabilization technique incorporating the long head of the biceps tendon onto the anterior glenoid rim via trans-subscapular transfer, in conjunction with Hill-Sachs remplissage. A practical, step-by-step surgical technique for a complete reconstruction of the anterior capsule-labral-ligamentous complex is provided. This involves utilizing a soft-tissue dynamic anterior sling, achieved through the trans-subscapularis transfer of the long head of the biceps tendon at the glenoid level. The procedure concludes with a Hill-Sachs remplissage to further prevent off-track events and alleviate apprehension.

Conclusion: Dynamic anterior stabilization is a suitable approach for addressing recurring anterior shoulder instability in skeletally immature patients who have subcritical glenoid bone loss and bipolar bone lesions.

Keywords

Anterior shoulder instability / Bankart repair / Complications in shoulder instability procedures / Dynamic anterior stabilization / Glenoid bone loss / Remplissage

References

[1] Bah A, Lateur GM, Kouevidjin BT, Bassinga JYS, Issa M, Jaafar A, et al. Chronic anterior shoulder instability with significant Hill–Sachs lesion: arthroscopic Bankart with remplissage versus open Latarjet procedure. Orthop Traumatol Surg Res. 2018;104(1):17–22.

[2] Watkins RA, De Borja C, Ramirez F. Common upper extremity injuries in pediatric athletes. Curr Rev Musculoskelet Med. 2022;15(6):465–473.

[3] Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N, et al. Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2021;29(1):192–201.

[4] Franklin CC, Weiss JM. The natural history of pediatric and adolescent shoulder dislocation. J Pediatr Orthop. 2019;39:S50–S52.

[5] Camus D, Domos P, Berard E, Toulemonde J, Mansat P, Bonnevialle N. Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: a meta-analysis. Orthop Traumatol Surg Res. 2018;104(6):803–809.

[6] Hughes JL, Bastrom T, Pennock AT, Edmonds EW. Arthroscopic Bankart repairs with and without remplissage in recurrent adolescent anterior shoulder instability with hill-Sachs deformity. Orthop J Sports Med. 2018;6(12):2325967118813981.

[7] Schwihla I, Wieser K, Grubhofer F, Zimmermann SM. Long-term recurrence rate in anterior shoulder instability after Bankart repair based on the on- and off-track concept. J Shoulder Elbow Surg. 2023;32(2):269–275.

[8] Haroun HK, Sobhy MH, Abdelrahman AA. Arthroscopic Bankart repair with remplissage versus Latarjet procedure for management of engaging Hill-Sachs lesions with subcritical glenoid bone loss in traumatic anterior shoulder instability: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(10):2163–2174.

[9] Popescu IA, Neculau DC, Simion C, Popescu D. Modified dynamic anterior stabilization (DAS) and hill-Sachs Remplissage for the treatment of recurrent anterior shoulder dislocation. Arthrosc Tech. 2022;11(2):e147–e152.

[10] Popescu IA, Haeni D. Complications of bony procedures for shoulder instability. In: Lafosse L, Agneskirchner J, Lafosse T, editors. Complications in Arthroscopic Shoulder Surgery. Cham: Springer International Publishing; 2020. p. 51–64.

[11] de Campos Azevedo C, Ângelo AC. Onlay dynamic anterior stabilization with biceps transfer for the treatment of anterior glenohumeral instability produces good clinical outcomes and successful healing at a minimum 1 year of follow-up. Arthrosc Sports Med Rehabil. 2023;5(2):e445–e457.

[12] Lafosse T, Fogerty S, Idoine J, Gobezie R, Lafosse L. Hyper extension-internal rotation (HERI): a new test for anterior gleno-humeral instability. Orthop Traumatol Surg Res. 2016;102(1):3–12.

[13] O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26(5):610–613.

[14] Lafosse T, Kopel L, Beckers J, Lafosse L. The 360 double lasso loop for biceps tenodesis: tips and tricks. Arthrosc Tech. 2021;10(8):e1889–e1895.

[15] Collin P, Lädermann A. Dynamic anterior stabilization using the long head of the biceps for anteroinferior glenohumeral instability. Arthrosc Tech. 2018 Jan;7(1):e39–e44.

[16] Monroe EJ, Brand JC. Editorial commentary: dynamic anterior stabilization via biceps tenodesis to the glenoid is an option for anterior shoulder instability with subcritical glenoid bone loss. Art Ther. 2022;38(6):1772–1773.

[17] Domos P, Chelli M, Lunini E, Ascione F, Bercik MJ, Neyton L, et al. Clinical and radiographic outcomes of the open Latarjet procedure in skeletally immature patients. J Shoulder Elbow Surg. 2020;29(6):1206–1213.

[18] Hanson JA, Foster MJ, Pearce SS, Millett PJ. Primary Latarjet for anterior shoulder instability in adolescents: an unstable conclusion: commentary on an article by Manuel Waltenspül, MD, et al.: “long-term results and failure analysis of the open Latarjet procedure and arthroscopic Bankart repair in adolescents”. J Bone Joint Surg Am. 2022;104(12):1129.

[19] Feng S, Chen M, Chen J, Li H, Chen J, Chen S. Patient outcomes and fear of returning to sports after arthroscopic Bankart repair with Remplissage. Orthop J Sports Med. 2021;9(4):23259671211001775.

[20] Hurley ET, Schwartz LB, Mojica ES, Campbell KA, Matache BA, Meislin RJ, et al. Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg. 2021;30(7):1693–1699.

[21] Alkaduhimi H, Verweij LPE, Willigenburg NW, van Deurzen DFP, van den Bekerom MPJ. Remplissage with Bankart repair in anterior shoulder instability: a systematic review of the clinical and cadaveric literature. Art Ther. 2019;35(4):1257–1266.

[22] Brilakis E, Avramidis G, Malahias MA, Stathellis A, Deligeorgis A, Chiotis I, et al. Long-term outcome of arthroscopic remplissage in addition to the classic Bankart repair for the management of recurrent anterior shoulder instability with engaging Hill–Sachs lesions. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):305–313.

[23] Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719–1725.

[24] Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755–1763.

[25] Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, et al. The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am. 2013;95(15):1390–1397.

[26] Kelly AM, Kelly JD. Editorial commentary: shoulder remplissage is a beneficial addition to Bankart or glenoid bone loss treatment: stay on track and use wisely. Art Ther. 2023;39(3):703–705.

[27] Collin P, Nabergoj M, Denard PJ, Wang S, Bothorel H, Lädermann A. Arthroscopic biceps transfer to the glenoid with Bankart repair Grants satisfactory 2-year results for recurrent anteroinferior glenohumeral instability in subcritical bone loss. Arthroscopy. 2022;38(6):1766–1771.

[28] Roberts SB, Beattie N, McNiven ND, Robinson CM. The natural history of primary anterior dislocation of the glenohumeral joint in adolescence. Bone Joint J. 2015;97-B(4):520–526.

[29] Clinker CE, Chalmers PN, Romeo A. Anchorless labral repair for recurrent shoulder instability in the skeletally immature. Arthrosc Tech. 2022;11(11):e2049–e2053.

[30] Longo UG, Loppini M, Rizzello G, Ciuffreda M, Maffulli N, Denaro V. Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30(4):506–522.

[31] Khan A, Samba A, Pereira B, Canavese F. Anterior dislocation of the shoulder in skeletally immature patients: comparison between non-operative treatment versus open Latarjet's procedure. Bone Joint J. 2014;96-B(3):354–359.

[32] Boileau P, Lemmex DB. Editorial commentary: which patients are likely to undergo redislocation after an arthroscopic Bankart repair? Preoperative instability severity index scoring over 3 points—the game is over! Art Ther. 2019;35(2):367–371.

[33] Yamamoto N, Shinagawa K, Hatta T, Itoi E. Peripheral-track and central-track Hill-Sachs lesions: a new concept of assessing an on-track lesion. Am J Sports Med. 2020;48(1):33–38.

[34] Popescu IA, Teboul F, Goubier JN, Ghazanfari A. In-office shoulder arthroscopy and tenotomy of the long head of the biceps tendon-a cadaveric feasibility study. Int Orthop. 2019;43(10):2361–2365.

[35] Avram GM, Neculau DC, Obada B, Pomenta Bastidas MV, Popescu D, Fiodorovas M, et al. Partial articular supraspinatus tendon avulsion repair and patch: a technical note for augmenting the supraspinatus reinsertion with the long head of the biceps tendon. Orthop Surg. 2023;15(8):2174–2180.

[36] Lädermann A. Editorial commentary: the long head of the biceps tendon is useful for shoulder reconstruction including glenohumeral stabilization: from biceps killers to biceps users. Arthroscopy. 2023;39(2):202–203.

RIGHTS & PERMISSIONS

2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.