Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage With Bankart Repair in Abduction–External Rotation Position

Abstract

Background: Hill-Sachs lesion (HSL) remplissage with Bankart repair (RMBR) provides a minimally invasive solution for treating HSLs and glenoid bone defects of <25%. The infraspinatus tendon is inserted into the HSL during the remplissage process, causing the infraspinatus to shift medially, leading to an unknown effect on glenohumeral alignment during the resting abduction–external rotation (ABER) and muscle-active states. Purpose/Hypothesis: The purpose of this study was to evaluate the possible check-rein effect and muscle-active control in stabilizing the glenohumeral joint after RMBR in vivo. We hypothesized that the check-rein effect and active control would stabilize the glenohumeral joint in the ABER position in patients after RMBR. Study Design: Controlled laboratory study. Methods: We included 42 participants—22 patients in group A who met the inclusion criteria after RMBR and 20 healthy participants in group B without shoulder laxity. Three-dimensional magnetic resonance imaging was performed to analyze the alignment relationship of the glenohumeral joint with and without muscular activity. Ultrasonic shear wave elastography was used to evaluate the elastic properties of the anterior capsule covered with the anterior bands of the inferior glenohumeral ligament. Results: Patients who underwent RMBR demonstrated more posterior (–1.81 ± 1.19 mm vs –0.76 ± 1.25 mm; P = .008) and inferior (–1.05 ± 0.62 mm vs –0.45 ± 0.48 mm; P = .001) shifts of the humeral head rotation center and less anterior capsular elasticity (70.07 ± 22.60 kPa vs 84.01 ± 14.08 kPa; P = .023) than healthy participants in the resting ABER state. More posterior (–3.17 ± 0.84 mm vs –1.81 ± 1.19 mm; P < .001) and less-inferior (–0.34 ± 0.56 mm vs –1.05 ± 0.62 mm; P < .001) shifts of the humeral head rotation center and less anterior capsular elasticity (36.57 ± 13.89 kPa vs 70.07 ± 22.60 kPa; P < .001) were observed in the operative shoulder during muscle-active ABER than in resting ABER states. Conclusion: The check-rein effect and muscle-active control act as stabilizing mechanisms in RMBR during the ABER position. Clinical Relevance: Stabilizing mechanisms in RMBR during the ABER position include the check-rein effect and muscle-active control.