Video journal of sports medicine最新文献

{"title":"Latarjet Procedure for Recurrent Anterior Shoulder Instability.","authors":"Marc Lubitz, Anup Shah, Evan Lederman","doi":"10.1177/26350254251327193","DOIUrl":"https://doi.org/10.1177/26350254251327193","url":null,"abstract":"<p><strong>Background: </strong>The Latarjet procedure is widely used to treat recurrent anterior shoulder instability, especially in cases with significant glenoid bone loss. The procedure involves transferring the coracoid process to the anterior inferior glenoid. Typically performed as an open surgery, arthroscopic Laterjet techniques have evolved, each offering unique benefits and challenges.</p><p><strong>Indications: </strong>The Latarjet procedure is indicated for patients with recurrent anterior shoulder instability, particularly those with substantial glenoid bone loss (typically >20%), or failed soft tissue (Bankart) repairs. It is also recommended for patients with engaging Hill-Sachs lesions (off-track), and high-risk individuals following their first dislocation. The glenoid track concept assists in evaluating bone loss and deciding when the Latarjet is warranted.</p><p><strong>Technique description: </strong>The patient is positioned in a beach-chair setup with anesthesia administered. An anterior incision is made using a deltopectoral approach. The coracoid is mobilized and prepared for the congruent arc technique, then affixed to the anterior glenoid using screws. The joint is irrigated, and the capsule and subscapularis are repaired to ensure stability and preserved mobility.</p><p><strong>Results: </strong>The congruent arc modification has shown favorable outcomes, particularly in patients with significant glenoid bone loss. Meta-analyses reveal a low redislocation rate (1.1%) and high return-to-sport rate (94.3%). Graft integration rates are approximately 92.1%, and patients report improved shoulder function, with notable gains in Rowe and American Shoulder and Elbow Surgeons scores.</p><p><strong>Discussion/conclusion: </strong>While the Latarjet procedure provides excellent stability and functionality for shoulder instability, risks such as graft fragmentation and screw malposition require careful planning and execution. The procedure's high success rate and favorable functional outcomes solidify its role in managing complex shoulder instability, ensuring its continued relevance in orthopaedic practice.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254251327193"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-Revision ACLR: Operative Considerations.","authors":"Hansel Ihn, Elaine Shing, Travis Maak","doi":"10.1177/26350254241303559","DOIUrl":"10.1177/26350254241303559","url":null,"abstract":"<p><strong>Background: </strong>Re-revision anterior cruciate ligament reconstruction (ACLR) is a challenging clinical problem. A multifactorial approach to this situation is necessary to address each patient's needs fully.</p><p><strong>Indications: </strong>Persistent instability.</p><p><strong>Technique description: </strong>Contralateral bone-patellar tendon-bone ACLR with tibial bone defect bone grafting and postfixation of the tibial bone plug. Concomitant lateral extra-articular tenodesis was also performed.</p><p><strong>Results: </strong>At the 12-week follow-up, the patient had regained full range of motion and demonstrated sagittal stability on examination. However, with published data consistently demonstrating low return to preinjury level of activity, we remain cautiously optimistic with regard to her eventual outcome.</p><p><strong>Discussion/conclusion: </strong>While it is important to be privy to the latest literature, it is also important to consider each patient's case individually. Consideration should be given to the patient's pertinent history and physical examination findings and not just radiographic parameters. Revision situations often present unforeseen challenges, so it is important to have contingency plans in place. Adopting techniques that minimize potential challenges, such as tunnel convergence, can be critical in successfully completing a surgery.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241303559"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Implantable Shock Absorber (MISHA) to Treat Medial Knee Arthritis in an Active Patient.","authors":"Yazdan Raji, Begum Topkarci, Monica S Vel, Wyatt Andersen, Robert M Putko, Seth L Sherman","doi":"10.1177/26350254241303558","DOIUrl":"10.1177/26350254241303558","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis is a leading cause of disability worldwide and most commonly affects the knee. Conservative management has limited long-term efficacy, and traditional surgical options present inherent challenges for the high-demand patient population, creating a treatment gap. Medial implantable shock absorber (MISHA) technology has been recently approved by the US Food and Drug Administration (FDA) for active patients with symptomatic medial compartment arthritis who are either unable or unwilling to undergo high tibial osteotomy (HTO) or arthroplasty. Select advantages include early return to full weightbearing without bracing, reversibility without \"burning bridges,\" and favorable patient-reported outcomes.</p><p><strong>Indications: </strong>We present a 58-year-old female, active military officer with a 9-month history of symptomatic medial knee osteoarthritis who had conservative measures that failed. Following informed consent regarding surgical options, the patient underwent left knee arthroscopy followed by open implantation of the MISHA Knee Implant.</p><p><strong>Results: </strong>Medial internal shock absorbers can serve to shield the medial compartment from abnormal loads, reduce pain, and improve function without altering the native knee joint or lower extremity anatomy. In a prospective nonrandomized cohort study supervised by the FDA, a comparison between MISHA and HTO demonstrated the favorable outcomes of the MISHA group in terms of pain, function, adverse events, implant integrity, and conversion surgery at the primary end point of 24 months.</p><p><strong>Discussion/conclusion: </strong>In this surgical technique, we outline the key steps for implantation of the medial internal shock absorber to treat symptomatic medial compartment osteoarthritis in an active patient. We also review technical pearls and pitfalls and postoperative care, including rehabilitation and return to activity timelines and expectations.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241303558"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Technique, Tips, and Tricks: Medial Implantable Shock Absorber for Medial Compartment Knee Osteoarthritis.","authors":"Andrew S Bi, Wendell W Cole, Dylan Lowe, Alexander Golant, Laith M Jazrawi","doi":"10.1177/26350254241303551","DOIUrl":"10.1177/26350254241303551","url":null,"abstract":"<p><strong>Background: </strong>Isolated medial compartment knee osteoarthritis (OA) presents a challenging problem to treat for knee surgeons, with a multitude of options from conservative management, including injections and unloader braces, meniscal procedures, osteotomies, and unicompartmental knee arthroplasty (UKA). A new medial implantable shock absorber (MISHA) allows for offloading 142 N of the medial compartment during stance phase of gait.</p><p><strong>Indications: </strong>US Food and Drug Administration approval was obtained on April 10, 2023, with the following indications: isolated medial knee OA (Kellgren-Lawrence grades I-IV) that failed 6 months of conservative management, ages 25 to 65 years, body mass index <35 or body weight <300 lbs, <15° of varus, no flexion contracture >10°, and no significant medial osteophytes or medial meniscal extrusion.</p><p><strong>Technique description: </strong>A longitudinal medial knee incision is made 1 cm proximal to the medial epicondyle to the pes insertion, around 3 cm medial to the tibial tubercle, exposing the superficial medial collateral ligament, and medial joint line. The establishment of the femoral anisometric point is critical to provide a 4-mm posterior condylar offset in 90° of flexion compared to full extension. A trial implant can be placed to confirm appropriate anisometry, implant loading in extension, and relaxation in flexion. The final implant is placed and the titanium femoral and tibial baseplates are fixed with 3 unicortical titanium locking screws each.</p><p><strong>Results: </strong>Expected results per recommended postoperative protocol are immediate weightbearing without range of motion restrictions. From author experience, patients typically feel improvement and return to sport more rapidly than with anterior cruciate ligament reconstructions. Recovery and return to work are faster than osteotomies or UKAs based on comparative short-term studies. While long-term results are lacking given the novelty of the procedure, prospective studies have demonstrated 100% arthroplasty-free survival at 2 years and 85% survival at 5 years.</p><p><strong>Discussion/conclusion: </strong>The MISHA is a viable option for isolated medial compartment knee OA that provides a joint-preserving alternative to arthroplasty and a less morbid alternative to osteotomy. This treatment can be technically difficult to perform, but several pearls and techniques can offer a reproducible, minimally invasive surgery and good functional results.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241303551"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trochleoplasty With Combined Soft Tissue Reconstruction for Patellar Instability.","authors":"Steven Magister, Jose Perez, Charles Lin, Dylan Lowe, James L Pace, Laith Jazrawi","doi":"10.1177/26350254241310257","DOIUrl":"10.1177/26350254241310257","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability is a relatively common condition and is multifactorial in its cause, with both soft tissue and bony components. Trochleoplasty is a newly described surgical procedure to help improve outcomes following patellar restabilization.</p><p><strong>Indications: </strong>Trochleoplasty is an emerging surgical technique during patellar stabilization surgery in those patients with underlying trochlear dysplasia.</p><p><strong>Technique description: </strong>Trochleoplasty was performed via an open medial parapatellar arthrotomy. Using a combination of osteotome and guided bur, the subchondral surface was undermined to produce a deeper sulcus. The cartilage surface was then plastically deformed into the newly developed trochlea. Trochleoplasty was then secured with a central triple-loaded interference screw and 3 peripheral interference screws. Medial patellofemoral ligament reconstruction was then performed in standard fashion.</p><p><strong>Results: </strong>Postoperative course was complicated by arthrofibrosis, which required manipulation at 4 weeks. Following manipulation, the patient recovered uneventfully and had returned to full activities at 6 months with full strength, range of motion, and minimal pain.</p><p><strong>Discussion/conclusion: </strong>Trochleoplasty with combined soft tissue reconstruction is a viable treatment option in those patients with recurrent patellar instability and underlying trochlear dysplasia. While not without complications, this surgical technique remains a powerful tool in the correctly indicated patient. Appropriate patient selection and adherence to postoperative rehabilitation are crucial for optimal outcomes.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241310257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteochondral Lesions of the Tibial Plafond: A Restorative Procedure for Cystic Defects.","authors":"Francis Bustos, Richard Ferkel","doi":"10.1177/26350254241310255","DOIUrl":"10.1177/26350254241310255","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the tibia plafond (OLTPs) are an uncommon problem that can generate pain.</p><p><strong>Indications: </strong>Arthroscopic techniques can provide symptomatic relief and improved outcomes when conservative management has failed.</p><p><strong>Technique description: </strong>We present our arthroscopic technique for managing osteochondral lesions of the distal tibia with subchondral cyst formation. By addressing the lesion with bone marrow aspirate concentrate mixed with micronized cartilage matrix and sealing with fibrin glue, we achieve stable restoration of the osteochondral lesion in a competitive athlete.</p><p><strong>Results: </strong>This operative intervention has been shown in clinical series to improve American Orthopaedic Foot & Ankle Society ankle-hindfoot scores postoperatively.</p><p><strong>Discussion/conclusion: </strong>This restorative procedure for OLTP cystic defects has been shown to produce good to excellent results and is a viable, minimally invasive option in the competitive athlete.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241310255"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12146672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterolateral Segmental Meniscal Allograft Transplantation.","authors":"Emily Whicker, Eddie K Afetse, Jonathan Godin","doi":"10.1177/26350254241300184","DOIUrl":"10.1177/26350254241300184","url":null,"abstract":"<p><strong>Background: </strong>The medial and lateral menisci increase joint congruity, stabilization, shock absorption, and proprioception. Deficient menisci provide challenges for orthopaedic surgeons and often require meniscal transplantation. Current techniques for meniscal transplant may sacrifice native healthy meniscus that could be preserved.</p><p><strong>Indications: </strong>We present a novel technique for anterolateral segmental meniscal transplant, which serves to replace the deficient anterolateral meniscus with the preservation of the intact posterior midbody and horn.</p><p><strong>Technique description: </strong>Using meniscal root, all-inside, and outside-in meniscal repair techniques, we present a successful segmental anterolateral meniscal transplant.</p><p><strong>Results: </strong>While only limited short-term outcomes are available due to the novel nature of this procedure, our patient is following the same protocol as a total meniscal transplant without any complications.</p><p><strong>Discussion/conclusion: </strong>While long-term and larger cohorts are needed, segmental meniscal transplant is a potential novel technique to address non-total meniscal deficiency without sacrificing healthy meniscal tissue.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241300184"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Portal Placement for ACL Femoral Tunnel Drilling With an Over-the-Top Guide: Concepts and Technique.","authors":"Travis Baes, Michael Gaudiani, Vasilios Moutzouros","doi":"10.1177/26350254241302100","DOIUrl":"10.1177/26350254241302100","url":null,"abstract":"<p><strong>Background: </strong>The rate of graft failure after anterior cruciate ligament (ACL) reconstruction ranges from 3% to 22%. Surgeons must mitigate risks of failure by limiting technical errors. Femoral tunnel malposition has been cited as the most common technical error associated with ACL reconstruction. As such, techniques for femoral tunnel drilling have evolved to ensure placement of the tunnel within the anatomic footprint of the native ACL. If using an over-the-top guide, the placement of the medial portal becomes critical to ensure safe and accurate drilling.</p><p><strong>Indications: </strong>The purpose of this video is to highlight key concepts related to the proper placement of the medial portal during ACL reconstruction when using an over-the-top guide and low-profile reamer.</p><p><strong>Technique description: </strong>A skin marking for the planned medial portal is made approximately 1.5 to 2 cm medial to the patellar tendon while palpating the joint line. After standard bone-patella tendon-bone (BTB) autograft harvest and anterolateral portal establishment, the medial portal is created under direct visualization, utilizing an 18-gauge spinal needle to ensure proper trajectory for over-the-top femoral tunnel drilling. After the tibial tunnel is prepared, the over-the-top guide is inserted via the medial portal and hooked onto the back wall. The knee is then hyperflexed and the beath pin is advanced out the lateral thigh. The low-profile reamer is advanced over the wire and reamed to the desired tunnel depth. The back wall integrity is confirmed and the prepared autograft is then passed and secured via interference screw fixation.</p><p><strong>Results: </strong>This technique provides a consistent and reproducible method of femoral tunnel placement in the anatomic footprint of the ACL without damaging the medial femoral condyle. We can also instrument through the same portal to treat meniscal pathology without necessitating an accessory medial portal.</p><p><strong>Discussion/conclusion: </strong>Appropriate medial portal placement for femoral tunnel drilling with an over-the-top guide is critical for safe, reproducible, and consistent tunnel location.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241302100"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Humeral Head Allograft and Open Bankart Repair Through an Anterior Approach.","authors":"Andromahi Trivellas, Zoe Hinton, Jonathan F Dickens","doi":"10.1177/26350254251320956","DOIUrl":"10.1177/26350254251320956","url":null,"abstract":"<p><strong>Background: </strong>Shoulder instability events can often result in humeral head and glenoid bone defects. Lesion size, patient age, bone quality, and cause of instability affect management. Surgical options are numerous, depending on severity and complexity. In addressing posterior humeral head lesions, remplissage and humeral head allograft have been reliably described, but the approach to addressing these often significant lesions has been variably illustrated. As recently described by Yazdi et al in a systematic review in 2022, osteochondral allografts for Hill-Sachs or reverse Hill-Sachs lesions showed good patient-reported outcomes. This is in agreement with other studies in the literature, including another systematic review by Saltzman et al in 2015 that reported good outcomes after humeral head allografts for humeral head defects, as well as another study by Gerber et al that reported similar promising outcomes.</p><p><strong>Indications: </strong>Humeral head allograft should be considered in the setting of instability refractory to nonoperative measures in younger patients with large Hill-Sachs and reverse Hill-Sachs lesions, particularly in those that are engaging with the glenoid through range of motion and are over 30% of the depth of the humeral head.</p><p><strong>Technique description: </strong>Following an examination under anesthesia and diagnostic arthroscopy, a deltopectoral incision was made from the coracoid to the deltoid insertion. The subscapularis tendon and anterior capsule were both carefully released from their humeral insertion and tagged. Following external rotation of ~180°, the Hill-Sachs defect was visualized, debrided, and molded with bone wax. After an osteochondral humeral head allograft was sized and sculpted on the back table, it was positioned and fixated with provisional Kirscher wires followed by 4-0 cannulated, headless compression screws. Finally, an open Bankart repair was completed, followed by a capsular closure and subscapularis repair.</p><p><strong>Results: </strong>Humeral head allografts have demonstrated short-term improvements in motion and patient-reported outcome measures and can be used for posterior Hill-Sachs lesions, fully accessible through an anterior approach when anterior instability procedures are also warranted.</p><p><strong>Discussion/conclusion: </strong>Management of large Hill-Sachs and reverse Hill-Sachs lesions with a humeral head allograft using an anterior open approach is a viable option for patients with refractory instability.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254251320956"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Shoulder Instability: To Remplissage or Not to Remplissage.","authors":"Natalie A Lowenstein, Sercan Yalcin, Madeline M McGovern, Jillian L Mazzocca, Elizabeth G Matzkin, Giovanna Medina","doi":"10.1177/26350254241312923","DOIUrl":"10.1177/26350254241312923","url":null,"abstract":"<p><strong>Background: </strong>Anterior shoulder instability, with either a bony Bankart lesion or Hill-Sachs defect, increases the risk of failure after arthroscopic labral repair (ALR)-specifically, bipolar lesions that are \"off-track\" or have an increased propensity for recurrent dislocation. Nonoperative management with the strengthening of the cuff and periscapular region and bracing can be attempted, but surgical intervention is recommended for patients with recurrent dislocation, Hill-Sachs lesion, and glenoid bone loss or high-risk athletes. Remplissage, which is an arthroscopic technique in which the infraspinatus tendon is attached to the Hill-Sachs defect, has been used more frequently in the past few years, given the recent literature showing high rates of recurrent instability after ALR.</p><p><strong>Indications: </strong>Ideal remplissage techniques have been debated with some surgeons using anchors with knot fixation and access through the subacromial space at the level of the teres minor, which creates technical difficulty and adds to surgical time. The utilization of 2 single-loaded, knotless, all-suture anchors accessed through the posterior portal and infraspinatus tendon allows for easier visualization, capsulotenodesis, and anatomic approximation of the humeral head to the rotator cuff without the need to access the subacromial space, which makes surgery faster and easier.</p><p><strong>Technique description: </strong>The remplissage technique is an augmentation to ALR. It is performed with 2 single-loaded all-suture anchors using a posterior portal through the infraspinatus tendon into the Hill-Sachs lesion.</p><p><strong>Results: </strong>ALR with remplissage provides adequate anterior shoulder stability for patients with \"off-track\" lesions using a small percutaneous incision through the infraspinatus tendon and placement of 2 knotless all-suture anchors.</p><p><strong>Discussion/conclusion: </strong>Prior studies have demonstrated that adding remplissage to ALR leads to fewer recurrent dislocations postoperatively, especially in contact athletes. Recent literature demonstrates this benefit in patients with both on-track and off-track lesions. A multicenter review found that remplissage in addition to ALR protects against subsequent dislocation and improved patient outcomes.</p><p><strong>Patient consent disclosure statement: </strong>The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.</p>","PeriodicalId":520531,"journal":{"name":"Video journal of sports medicine","volume":"5 3","pages":"26350254241312923"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}