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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(01): 013-019
DOI: 10.1016/j.rbo.2017.10.010
Original Article | Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Resultados clínicos e de imagem da abordagem da lesão de Hill-Sachs pela técnica de remplissage na instabilidade anterior do ombro[*]

Article in several languages: português | English
Flávio de Oliveira França 
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
,
André Couto Godinho
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
3   Hospital Belo Horizonte, Belo Horizonte, MG, Brasil
,
Diego Pedrosa Capitol Carneiro Leal
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
,
Mateus Matos Mantovani
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
,
Rafael Rodrigues Frazão
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
,
Ricardo Ferreira Mariz
1   Hospital Ortopédico, Belo Horizonte, MG, Brasil
2   Hospital Belvedere, Belo Horizonte, MG, Brasil
› Author Affiliations
Further Information

Publication History

25 July 2017

24 October 2017

Publication Date:
01 March 2019 (online)

Also available at
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Resumo

Objetivos

Avaliar o resultado funcional da técnica de remplissage, a cicatrização da capsulotenodese do tendão infraespinal no defeito de Hill-Sachs, o grau de infiltração gordurosa do músculo infraespinal e sua força de rotação lateral no pós-operatório.

Método

Foram avaliados 25 pacientes com luxação anterior recidivante do ombro e lesão de Hill-Sachs com índice de Hardy maior do que 20%, submetidos à técnica artroscópica de remplissage com seguimento mínimo de um ano. Os pacientes foram submetidos a avaliação clínica (escores funcionais de Carter-Rowe e Walch-Duplay, medição de amplitude de movimento e força) e exame de ressonância magnética no ombro operado.

Resultados

Dos pacientes, 88% e 92% apresentaram resultados bons ou excelentes nas avaliações funcionais pelos escores de Carter-Rowe e Walch-Duplay, respectivamente. Identificou-se diferença média de 1 kg a menos de força do membro operado em relação ao contralateral (p < 0,001) e diferença média de 10∘ em rotação lateral 1 e 2 (p < 0,001), novamente com o uso como referência do lado contralateral. Todos os pacientes submetidos a ressonância magnética apresentaram preenchimento de alto grau da lesão de Hill-Sachs pela capsulotenodese, assim como ausência ou mínima infiltração gordurosa no músculo infraespinal.

Conclusão

A técnica de remplissage apresentou resultados bons/excelentes nos escores funcionais, apesar da perda discreta de força e amplitude de rotação lateral com significância estatística. Foram observados resultados excelentes quanto à cicatrização da capsulotenodese e ao preenchimento do defeito de Hill-Sachs.

Palavras-chave

ombro - instabilidade articular - recidiva - lesões de Bankart - artroscopia

* Trabalho desenvolvido no Hospital Ortopédico, Belo Horizonte, MG, Brasil. Publicado originalmente por Elsevier Editora Ltda. © 2018 Sociedade Brasileira de Ortopedia e Traumatologia.


 

  • Referências

  • 1 Hill HA, Sachs MD. The grooved defect of the humeral head: a frequently unrecognized complication of dislocations of the shoulder joint. Radiology 1940; 690-700
    Google Scholar
  • 2 Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 1989; 5 (04) 254-7
    CrossrefPubMedGoogle Scholar
  • 3 Spatschil A, Landsiedl F, Anderl W, Imhoff A, Seiler H, Vassilev I. , et al. Posttraumatic anterior-inferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 2006; 126 (04) 217-22
    CrossrefPubMedGoogle Scholar
  • 4 Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000; 16 (07) 677-94
    CrossrefPubMedGoogle Scholar
  • 5 Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y. , et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 2007; 16 (05) 649-56
    CrossrefPubMedGoogle Scholar
  • 6 Wolf EM, Pollack ME. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2004; 20 (Suppl. 01) e14-5
    Google Scholar
  • 7 Godinho GG, Souza JMG, Freitas JMA, Santos FML, Vieira AW, João FM. Tratamento da instabilidade anterior do ombro: experiência com a técnica de Morgan. Rev Bras Ortop 1997; 32 (04) 265-71
    Google Scholar
  • 8 Garcia GH, Degen RM, Liu JN, Kahlenberg CA, Dines JS. Accuracy of suture passage during arthroscopic remplissage-what anatomic landmarks can improve it?: a cadaveric study. Orthop J Sports Med 2016; 4 (08) 2325967116663497
    Google Scholar
  • 9 Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 1978; 60 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 10 Walch G. Directions for the use of quotation of anterior instabilities of the shoulder. In: First Opne Congress of the Europe Society of Surgery of Jain NB, Wilcox RB 3 rd, Katz JN, Higgins LD(eds.). Clinical examination of the rotator cuff. PM R. 2013. ;5(1):45–56
    Google Scholar
  • 11 Jain NB, Wilcox III RB, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM R 2013; 5 (01) 45-56
    CrossrefPubMedGoogle Scholar
  • 12 Rhee YG, Cho NS, Yoo JH, Lee WG. Filling Index Score of Remplissage (FISOR): a useful measurement tool to evaluate structural outcome after remplissage. J Shoulder Elbow Surg 2015; 24 (04) 613-20
    CrossrefPubMedGoogle Scholar
  • 13 Hartzler RU, Bui CN, Jeong WK, Akeda M, Peterson A, McGarry M. , et al. Remplissage of an off-track Hill-Sachs lesion is necessary to restore biomechanical glenohumeral joint stability in a bipolar bone loss model. Arthroscopy 2016; 32 (12) 2466-76
    CrossrefPubMedGoogle Scholar
  • 14 Buza III JA, Iyengar JJ, Anakwenze OA, Ahmad CS, Levine WN. Arthroscopic Hill-Sachs remplissage: a systematic review. J Bone Joint Surg Am 2014; 96 (07) 549-55
    CrossrefPubMedGoogle Scholar
  • 15 Boileau P, O'Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg Am 2012; 94 (07) 618-26
    CrossrefPubMedGoogle Scholar
  • 16 Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “remplissage”: capsulotenodesis of the engaging large Hill-Sachs lesion. J Orthop Surg Res 2011; 6: 29
    CrossrefPubMedGoogle Scholar
  • 17 Merolla G, Paladini P, Di Napoli G, Campi F, Porcellini G. Outcomes of arthroscopic Hill-Sachs remplissage and anterior Bankart repair: a retrospective controlled study including ultrasound evaluation of posterior capsulotenodesis and infraspinatus strength assessment. Am J Sports Med 2015; 43 (02) 407-14
    CrossrefPubMedGoogle Scholar
  • 18 Zhu YM, Lu Y, Zhang J, Shen JW, Jiang CY. Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up. Am J Sports Med 2011; 39 (08) 1640-7
    CrossrefPubMedGoogle Scholar
  • 19 Franceschi F, Papalia R, Rizzello G, Franceschetti E, Del Buono A, Panascì M. , et al. Remplissage repair—new frontiers in the prevention of recurrent shoulder instability: a 2-year follow-up comparative study. Am J Sports Med 2012; 40 (11) 2462-9
    CrossrefPubMedGoogle Scholar
  • 20 Gracitelli MEC, Helito CP, Malavolta EA, Ferreira Neto AA, Benegas E, Prada FS. , et al. Results from filling “remplissage” arthroscopic technique for recurrent anterior shoulder dislocation. Rev Bras Ortop 20115; 46 (06) 684-90
    Google Scholar
  • 21 Garcia GH, Wu HH, Liu JN, Huffman GR, Kelly IV JD. Outcomes of the remplissage procedure and its effects on return to sports: average 5-year follow-up. Am J Sports Med 2016; 44 (05) 1124-30
    CrossrefPubMedGoogle Scholar
  • 22 Hardy P, Lopes R, Bauer T, Conso C, Gaudin P, Sanghavi S. New quantitative measurement of the hill-sachs lesion: aprognostic factor for clinical results of arthroscopic glenohumeral stabilization. Eur J Orthop Surg Traumatol 2012; 22: 541-7
    CrossrefGoogle Scholar
  • 23 Park MJ, Garcia G, Malhotra A, Major N, Tjoumakaris FP, Kelly IV JD. The evaluation of arthroscopic remplissage by high-resolution magnetic resonance imaging. Am J Sports Med 2012; 40 (10) 2331-6
    CrossrefPubMedGoogle Scholar