Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage Without Restricting Motion in the Setting of an Engaging Hill-Sachs Defect

Abstract

Background:

Numerous surgical options for the management of engaging Hill-Sachs lesions exist, of which remplissage has emerged as one of the most popular arthroscopic techniques. Remplissage is not without disadvantages, however, and has been demonstrated to potentially result in a loss of external rotation (ER) due to nonanatomic tethering of the infraspinatus tendon and a potential decrease in infraspinatus strength clinically.

Purpose:

The efficacy of posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect.

Study Design:

Controlled laboratory study.

Methods:

Eight fresh-frozen human cadaveric shoulders were utilized for the study. After testing baseline translation and motion, 30% Hill-Sachs lesions were created in each specimen. Three experimental groups were assembled: (1) isolated Bankart repair (HSD), (2) Bankart repair with remplissage (RM), and (3) Bankart repair with posterior medial capsular plication (PL). Biomechanical testing was performed to determine anterior translation, range of motion, and Hill-Sachs engagement. Translation and motion measurements were normalized to the baseline laxity values for each specimen.

Results:

A significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both the PL and RM groups compared with the HSD group throughout most of the joint loads tested (P < .05), but no significant differences were noted between the PL and RM groups at any load. The RM group had significantly less normalized ER at 60° of abduction compared with the HSD and PL groups (P < .05). There were no differences in internal rotation between the groups. All 8 specimens in the HSD group engaged, while no specimens in the RM and PL groups engaged (P < .001).

Conclusion:

In a cadaveric model, medial posterior capsular plication as an adjunct to Bankart repair offers similar resistance to anterior translation and Hill-Sachs engagement as compared with remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of ER compared with remplissage without any significant limitation of internal rotation.

Clinical Relevance:

Posterior medial capsular plication reduces translation and engagement similarly to remplissage, without any restriction in motion.