Arthroscopic Bankart Repair With Remplissage as an Alternative to Latarjet for Anterior Glenohumeral Instability With More Than 15% Glenoid Bone Loss

Abstract

Background: Surgical management of anterior shoulder instability continues to evolve. The clinical effectiveness of arthroscopic Bankart repair with remplissage (REMP) in patients with increasing glenoid bone loss (GBL) has not been thoroughly compared with Latarjet. Purpose/Hypothesis: The purpose of this study was to compare 2-year outcomes of REMP versus open Latarjet in patients with >15% GBL. We hypothesized that there would be no difference. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter, retrospective study was performed on a consecutive series of patients who underwent primary REMP or Latarjet by 4 shoulder specialists between August 2013 and December 2019 for >15% GBL. Procedure performance was based on shared decision making between the surgeon and patient. Baseline and 2-year postoperative range of motion (ROM) and the following patient-reported outcomes (PROs) were collected: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Return to sport, satisfaction, complications, recurrence, and revisions were reviewed. Results: A total of 47 patients were available for study, including 22 who underwent REMP and 25 who underwent Latarjet. Baseline demographic characteristics, ROM, and PROs were similar between the groups. Mean preoperative GBL (REMP 25.8% ± 7.8% vs Latarjet 25.1% ± 9.0%; P = .800) and off-track lesions (REMP 59.1% vs Latarjet 44.0%; P = .302) were similar. Postoperative change in external rotation favored Latarjet (10° ± 22° vs –4° ± 13°; P = .017). Postoperative PROs, return to the sports (86.4% vs 87.5%; P = .99), and satisfaction (95.5% vs 95.8%; P = .99) were similar between groups. There were no recurrent dislocations in either group. One infected hematoma was encountered in the Latarjet cohort. Conclusion: At short-term follow-up, the hypothesis was upheld. REMP and Latarjet provided similar outcomes for patients with >15% GBL, although REMP patients experienced slightly decreased external rotation. Although larger series and longer-term follow-ups are required, remplissage may be considered in patients with >15% glenoid bone loss.

Bankart repair with remplissage vs. Latarjet procedure on recurrence, postoperative pain scores, external rotation, and Rowe score in patients with a Hill-Sachs lesion. A systematic review

“…Mean follow-up length varied across the studies from 24.7 to 74 months; follow-up length was not always similar between groups and not always separately reported for BR and Latarjet groups. All studies reported recurrence; while 4 studies 1 , 18 , 19 , 38 only reported recurrent dislocations, the other studies 4 , 11 , 22 , 40 reported recurrent instability. Preoperative ISI score was reported in 3 of the reviewed articles 4 , 11 , 40 with a mean value of 4.4 in the BR group and a mean value of 4.7 in the Latarjet group.…”

“… 1 , 4 , 11 , 40 Recent literature comparing BR and the Latarjet procedure in patients with a glenoid bone loss greater than 15% has shown similar recurrent instability rates. 18 While, BR has shown less recurrent instability than the Latarjet procedure in a study with a mean glenoid bone loss below 15%. 19 Contrastingly, the study of Hurley et al 22 showed reduced recurrent instability in the Latarjet group compared to the BR group.…”

Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review

“…Hurley et al [28] found higher rates of recurrent instability following ABR alone (16.8%) compared to OLP (7.0%) and ABR with remplissage (3.2%). A study by Horinek et al [20] compared OLP with ABR with remplissage, for anterior shoulder instability and found no difference in terms of clinical scores, return to sport, and satisfaction. In the present meta-analysis, only one study performed arthroscopic bony Bankart repair with remplissage (in 11 of 312 patients) [47] but did not report the outcomes of this subgroup.…”

Glenoid augmentation for subcritical bone loss: a narrative review

“…Contrary to the results suggesting the supremacy of Latarjet over arthroscopic, soft tissue-only repairs, Horinek et al recently demonstrated that ABR and remplissage yields similar 2 year outcomes to Latarjet in patients with >15% GBL ( 52 ). This lead the authors to conclude that remplissage is a consideration in patients with GBL >15% and it is notable that their cohort includes patients well beyond subcritical bone loss thresholds, with mean GBL in both groups of 25%.…”