Arthroscopic Remplissage Combined With Bankart Repair Results in a Higher Rate of Return to Sport in Athletes Compared With Bankart Repair Alone or the Latarjet Procedure: A Systematic Review and Meta-analysis

Abstract

Background: Traumatic anterior shoulder instability affects athletes at a higher rate compared with the general population. In recent years, indications for arthroscopic remplissage, an adjunct procedure classically used to reduce the recurrence of anterior shoulder instability in patients with off-track Hill-Sachs lesions, have expanded. Purpose: To investigate return-to-sport (RTS) rates, functional outcomes, and adverse events in athletes who underwent arthroscopic Bankart repair with remplissage compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature review of the Embase, PubMed (MEDLINE), and Web of Science databases was conducted for articles published before May 22, 2022. For the systematic review, 16 of 457 studies that reported RTS rates at any time point after remplissage were deemed eligible for inclusion in quantitative analysis and 17 of 457 studies in qualitative analysis. For the meta-analysis, 8 of 457 studies reported RTS rates after remplissage compared with surgical alternatives including Bankart repair alone or the Latarjet procedure and were deemed eligible for inclusion. Results: In total, 538 athletes underwent remplissage and were included in the study. RTS at any level was achieved by 86% (395/457) of patients, and the odds of RTS at any level were significantly higher after remplissage compared with surgical alternatives (odds ratio [OR], 2.71 [95% CI, 1.14-6.43]; P = .02). The odds of RTS at a previous or higher level were also significantly higher after remplissage compared with surgical alternatives (OR, 2.07 [95% CI, 1.29-3.31]; P = .002). The mean Rowe score increased significantly from 43.9 ± 7.77 preoperatively (n = 173) to 92.2 ± 4.02 after remplissage (n = 397) ( P < .001), but there was no significant difference in Rowe scores between remplissage and surgical alternatives ( P = .54). After remplissage, the recurrence rate was 5.0% for athletes (n = 220) and 7.3% for all patients (n = 634), with a mean time to recurrence of 24.0 ± 12.5 months. Reoperations occurred in 3.6% of athletes (n = 110) and 4.1% of all patients (n = 445). Recurrence and reoperations were significantly less likely after remplissage compared with surgical alternatives (OR, 0.18 [95% CI, 0.08-0.39]; P < .001 and OR, 0.17 [95% CI, 0.06-0.50]; P = .001, respectively). Conclusion: Arthroscopic Bankart repair with remplissage augmentation significantly improved RTS rates among athletes, both at any level and at previous levels of play. Additionally, remplissage appeared to significantly decrease recurrence and reoperation rates compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure.

Long-term Effectiveness and Outcome-Determining Factors of Arthroscopic Bankart Repair for Recreational Sports Population: An Assessment of 100 Patients With a Mean Follow-up of 12.7 Years

“…Recent studies have shown that open Bankart repair with inferior capsular shift, an additional remplissage procedure, or bony procedures such as the Latarjet procedure have demonstrated better outcomes in terms of recurrent instability compared with ABR alone. 5,8,11,18,21,28,38 However, concerns still exist regarding the limited long-term follow-up and relatively high rates of complication, such as reduced range of motion and accelerated osteoarthritis, associated with these procedures. 14,18,24,25,28,38 Therefore, it is important to evaluate the risk factors for recurrent instability to determine the appropriate surgical approach.…”

Anterior Shoulder Stabilization Using Single Needle-Assisted Outside-In Remplissage Technique and Bankart Repair

“…Moreover, it has been proven in previous research that remplissage can significantly reduce the recurrence and reoperation rates compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure. 14 …”

“…In patients with recurrent anterior shoulder instability, the combination of remplissage along with Bankart repair is reported to significantly reduce the recurrent shoulder dislocation and reoperation rates. 14 , 15 , 16 , 17 , 18 MacDonald et al. 15 concluded that the remplissage procedure had significantly lower rates of redislocation in high-risk patients with Hill–Sachs lesions ≥20 mm and/or ≥15% in size.…”

What’s New in Sports Medicine

“…However, indications have been expanding to include on-track lesions with subcritical glenoid bone loss. Davis et al looked at the return-to-sport rates, functional outcomes, and adverse events in athletes who underwent arthroscopic Bankart repair with remplissage compared with those who underwent Bankart repair alone or the Latarjet procedure 7 . In this study, 538 athletes underwent remplissage, with 86% (395 of 457) returning to sport at any level.…”