The effect of the remplissage procedure on shoulder range of motion: A cadaveric study

Rei Omi, Alexander W. Hooke, Kristin D Zhao, Tomoya Matsuhashi, Akira Goto, Nobuyuki Yamamoto, John W. Sperling, Scott P. Steinmann, Eiji Itoi, Kai Nan An

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. Methods: HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). Results: For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. Conclusions: In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. Clinical Relevance: The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance.

Original languageEnglish (US)
Pages (from-to)178-187
Number of pages10
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume30
Issue number2
DOIs
StatePublished - Feb 2014

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Articular Range of Motion
Humerus
Suture Anchors
Humeral Head
Rotator Cuff
Bankart Lesions
Torque
Athletes
Joints

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

The effect of the remplissage procedure on shoulder range of motion : A cadaveric study. / Omi, Rei; Hooke, Alexander W.; Zhao, Kristin D; Matsuhashi, Tomoya; Goto, Akira; Yamamoto, Nobuyuki; Sperling, John W.; Steinmann, Scott P.; Itoi, Eiji; An, Kai Nan.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 30, No. 2, 02.2014, p. 178-187.

Research output: Contribution to journalArticle

Omi, R, Hooke, AW, Zhao, KD, Matsuhashi, T, Goto, A, Yamamoto, N, Sperling, JW, Steinmann, SP, Itoi, E & An, KN 2014, 'The effect of the remplissage procedure on shoulder range of motion: A cadaveric study', Arthroscopy - Journal of Arthroscopic and Related Surgery, vol. 30, no. 2, pp. 178-187. https://doi.org/10.1016/j.arthro.2013.11.003
Omi, Rei ; Hooke, Alexander W. ; Zhao, Kristin D ; Matsuhashi, Tomoya ; Goto, Akira ; Yamamoto, Nobuyuki ; Sperling, John W. ; Steinmann, Scott P. ; Itoi, Eiji ; An, Kai Nan. / The effect of the remplissage procedure on shoulder range of motion : A cadaveric study. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2014 ; Vol. 30, No. 2. pp. 178-187.
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abstract = "Purpose: The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. Methods: HSLs of 50{\%} and 100{\%} of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). Results: For standard ROMs, the procedure for the 50{\%} HSL maintained complete ROMs, whereas the procedure for the 100{\%} HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50{\%} HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100{\%} HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. Conclusions: In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. Clinical Relevance: The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance.",
author = "Rei Omi and Hooke, {Alexander W.} and Zhao, {Kristin D} and Tomoya Matsuhashi and Akira Goto and Nobuyuki Yamamoto and Sperling, {John W.} and Steinmann, {Scott P.} and Eiji Itoi and An, {Kai Nan}",
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AU - Hooke, Alexander W.

AU - Zhao, Kristin D

AU - Matsuhashi, Tomoya

AU - Goto, Akira

AU - Yamamoto, Nobuyuki

AU - Sperling, John W.

AU - Steinmann, Scott P.

AU - Itoi, Eiji

AU - An, Kai Nan

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N2 - Purpose: The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. Methods: HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). Results: For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. Conclusions: In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. Clinical Relevance: The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance.

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