Bankart repair Ramplissage surgery
Remplissage (a French term meaning “to fill in”) involves a posterior capsulodesis and infraspinatus tenodesis performed arthroscopically in patients with anterior shoulder instability and engaging Hill-Sachs lesions.
The Hill-Sachs remplissage technique is similar to an arthroscopic repair of a partial-thickness, articular surface rotator cuff tear. It consists of fixation of the infraspinatus tendon and posterior capsule to the abraded surface of the Hill-Sachs lesion. It is a non-anatomic technique that renders the defect extra-articular to prevent instability, using an arthroscopic posterior capsulodesis and infraspinatus tenodesis into the Hill-Sachs defect, performed in conjunction with a Bankart repair.
The filling of the abraded Hill-Sachs lesion effectively obliterates it and converts the lesion into an extra-articular one. Therefore it prevents engagement.
In particular, the concern that the remplissage would limit rotation did not materialize. There was no significant loss of motion in any plane after the procedure.
Indication
Hill-Sachs defect >25 % in width, glenoid bone loss, <20 %, a more horizontal orientation/Hill-Sachs angle or engagement demonstrated during dynamic arthroscopic evaluation and a Hill-Sachs defect ending medial to the glenoid tract
Procedure
There are various adaptations of this procedure. Here is one video about it -
Advantages
Easier control of ROM without possible damage to previously reconstructed anterior-inferior capsulolabral structures |
Better visualization and easier reconstruction of the anterior-inferior capsulolabral structures because the humeral head moves more posteriorly |
Inserting the sutures from lateral to medial attaching the rotator cable, as well suturing in the horizontal plane, allows stronger fixation and avoids damage to the blood supply of the posterior capsule and infraspinatus tendon. |
Blind suturing during the remplissage procedure sometimes requires the surgeon to check the subacromial space. |
In cases with a concomitant supraspinatus rupture, orientation and determination of the rotator cable structure can be difficult. |
The healing timeframes associated with rotator cuff repair must be considered in order to optimize the healing of the tendon into the defect. As such, active and passive tension across this repair should be avoided for the first 6 weeks following surgery, and resistance to the posterior cuff avoided for 12 weeks. Based on these timeframes the following modifications to the anterior shoulder reconstruction rehab model follow remplissage:
Sling immobilization at all times except for showering
Therapeutic Exercise - Elbow/Wrist/Hand Range of Motion
Grip Strengthening
Discontinue sling immobilization
Range of Motion – Slowly Increase Forward Flexion, Internal/External Rotation as tolerated
Therapeutic Exercise - Continue with Elbow/Wrist/Hand Range of Motion and Grip Strengthening
Begin Prone Extensions and Scapular Stabilizing Exercises (trapezius/rhomboids/levator scapula)
Gentle joint mobilization
Modalities per PT discretion
Range of Motion – Progress to full AROM without discomfort
Therapeutic Exercise – Advance theraband exercises to light weights (1-5 lbs) - 8-12 repetitions/2-3 sets for Rotator Cuff, Deltoid and Scapular Stabilizers
Continue and progress with Phase II exercises
Begin UE ergometer
Modalities per PT discretion
Range of Motion – Full without discomfort
Therapeutic Exercise – Advance exercises in Phase III (strengthening 3x per week)
Sport/Work specific rehabilitation
Return to throwing at 4.5 months
Return to sports at 8 months if approved
Phase I (Weeks 0-6)
Phase II (Weeks 7-12)
Phase III (Months 3-6)
Phase IV (Months 6+)
For more details contact sukhayu hospital nashik or contact 7420004242
Keywords
cases
extra
width
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times
sports
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details
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Flexion
Deltoid
filling
lateral
surgeon
8 months
12 weeks
patients
suturing
Progress
bone loss
Phase III
full AROM
one video
Indication
resistance
engagement
Advantages
discomfort
4.5 months
conjunction
Motion Grip
orientation
French term
humeral head
blood supply
determination
articular one
light weights
first 6 weeks
Easier control
Bankart repair
posterior cuff
possible damage
abraded surface
passive tension
tract Procedure
significant loss
Hill-Sachs angle
horizontal plane
Prone Extensions
Advance exercises
Hill-Sachs defect
subacromial space
posterior capsule
stronger fixation
healing timeframes
anatomic technique
Phase II exercises
Hill-Sachs lesions
Ramplissage surgery
arthroscopic repair
PT discretion Range
rotator cuff repair
various adaptations
Therapeutic Exercise
infraspinatus tendon
Better visualization
Scapular Stabilizers
easier reconstruction
remplissage procedure
Elbow/Wrist/Hand Range
sukhayu hospital nashik
following modifications
infraspinatus tenodesis
UE ergometer Modalities
rotator cable structure
Physiotherapy Management
8-12 repetitions/2-3 sets
Internal/External Rotation
trapezius/rhomboids/levator
anterior shoulder instability
Scapular Stabilizing Exercises
dynamic arthroscopic evaluation
concomitant supraspinatus rupture
Sport/Work specific rehabilitation
arthroscopic posterior capsulodesis
articular surface rotator cuff tear
The Hill-Sachs remplissage technique
Gentle joint mobilization Modalities
Discontinue sling immobilization Range
anterior-inferior capsulolabral structures
anterior shoulder reconstruction rehab model
