Both Single- and Double-anchor Remplissage Techniques Restore Native Stability in a Cadaveric Model of Hill-Sachs Lesions in Anterior Shoulder Instability

To determine the most effective number and location of fixation points for remplissage of Hill-Sachs lesions (HSL) in a cadaveric model of anterior shoulder instability. Eleven fresh-frozen cadaveric shoulder specimens were tested. A robot device tested resistance to anterior translation of the humeral head. Eleven shoulder conditions were tested: (1) intact, (2) 15% HSL, (3) 15% HSL with 1 central, (4) 15% HSL with 2 central, (5) 15% HSL with 1 medial, (6) 15% HSL with 2 medial, (7) 30% HSL, (8) 30% HSL with 1 central, (9) 30% HSL with 2 central, (10) 30% HSL with 1 medial, and (11) 30% HSL with 2 medial. All remplissage techniques tested restored peak resistance to at least equal that of the intact shoulder condition. In the small Hill-Sachs condition, the mean peak resistance for 1 central, 2 central, 1 medial, and 2 medial fixation was 41.5, 52.3, 45.1, and 54.8, respectively. In the large Hill-Sachs condition, the mean peak resistance was 41.7, 59.9, 42.6, and 64.43, respectively. Two fixation points provided more resistance than one in both the medial (P < .01) and central (P < .01) locations. When comparing fixation location, however, there was not a significant difference between 1 central and 1 medial (P > .05) or 2 central to 2 medial (P > .05) in either the large or small HSL. All remplissage techniques were able to successfully restore mean peak resistance to anterior translation to the native condition in this cadaveric model. There was not a difference in resistance force between medial wall and central placement for either the single- or double-fixation configurations. This study suggests that one anchor placed either medially or centrally will restore native stability in remplissage for anterior shoulder instability.