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

OBJECTIVES: In the present study, the efficacy of a posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. METHODS: 8 fresh-frozen human cadaveric shoulders were utilized for the study. After testing ba...

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Autores principales: Werner, Brian C., Chen, Xiang, Camp, Christopher L., Kontaxis, Andreas, Dines, Joshua S., Gulotta, Lawrence Vincent
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542346/
http://dx.doi.org/10.1177/2325967117S00253
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author Werner, Brian C.
Chen, Xiang
Camp, Christopher L.
Kontaxis, Andreas
Dines, Joshua S.
Gulotta, Lawrence Vincent
author_facet Werner, Brian C.
Chen, Xiang
Camp, Christopher L.
Kontaxis, Andreas
Dines, Joshua S.
Gulotta, Lawrence Vincent
author_sort Werner, Brian C.
collection PubMed
description OBJECTIVES: In the present study, the efficacy of a posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. METHODS: 8 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 created: 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 measures for each specimen. RESULTS: Significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both PL and RM groups compared to the HSD group throughout most of the joint loads tested (p < 0.05) [Figure 1], but no significant differences were noted between PL and RM at any load. The RM group had significantly less normalized ER at 60° of abduction compared to the HSD and PL groups (p < 0.05). There were no differences in IR between the groups. All 8 HSD specimens engaged, while no specimens in the RM and PL groups engaged (p < 0.001). 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 to remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of external rotation compared to remplissage without any significant limitation of internal rotation.
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spelling pubmed-55423462017-08-24 Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect Werner, Brian C. Chen, Xiang Camp, Christopher L. Kontaxis, Andreas Dines, Joshua S. Gulotta, Lawrence Vincent Orthop J Sports Med Article OBJECTIVES: In the present study, the efficacy of a posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. METHODS: 8 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 created: 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 measures for each specimen. RESULTS: Significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both PL and RM groups compared to the HSD group throughout most of the joint loads tested (p < 0.05) [Figure 1], but no significant differences were noted between PL and RM at any load. The RM group had significantly less normalized ER at 60° of abduction compared to the HSD and PL groups (p < 0.05). There were no differences in IR between the groups. All 8 HSD specimens engaged, while no specimens in the RM and PL groups engaged (p < 0.001). 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 to remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of external rotation compared to remplissage without any significant limitation of internal rotation. SAGE Publications 2017-07-31 /pmc/articles/PMC5542346/ http://dx.doi.org/10.1177/2325967117S00253 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle Article
Werner, Brian C.
Chen, Xiang
Camp, Christopher L.
Kontaxis, Andreas
Dines, Joshua S.
Gulotta, Lawrence Vincent
Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title_full Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title_fullStr Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title_full_unstemmed Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title_short Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage without Restricting Motion in the Setting of an Engaging Hill Sachs Defect
title_sort medial posterior capsular plication reduces anterior shoulder instability similar to remplissage without restricting motion in the setting of an engaging hill sachs defect
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542346/
http://dx.doi.org/10.1177/2325967117S00253
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