Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability

Abstract

Purpose:We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation.Methods:Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively.Results: Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up.Conclusion: Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.

A prospective study of functional outcome of arthroscopic repair of recurrent anterior shoulder dislocation

“…Furthermore, in the present study, there was significant improvement in pre-op ROM of flexion (p<0.05), pre-op ROM of abduction (p<0.05), pre-op ROM of internal rotation (p<0.05), and pre-op ROM of external rotation (p<0.05). These findings were consistent with the studies of Ballal et al [19] , Miyamoto et al (2017) [22] , Grimberg et al (2016) [23] and Zhu et al (2011) [24] . Ballal et al [19] prospective study reported a significant improvement in range of motion with follow-ups at 1 month, 3 months and 6 months with all patients achieving at least 80 degree of external rotation with arm in abduction by the end of 6 months.…”

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

“…In their 2000 article, Burkhart and De Beer 3 reported that arthroscopic Bankart repair patients with bony defects were at a greater risk of recurrent dislocation. This has been echoed in subsequent studies 20, 21, 22, 23, 24. Currently, arthroscopic Bankart repair and the open Latarjet procedure are the preferred surgical techniques when addressing recurrent shoulder dislocation.…”

The Shoulder Instability: An Overview

“…63 For engaging Hill-Sachs lesion, arthroscopic Bankart procedure with remplissage provides better clinical outcomes with no recurrence, even though there is some restriction of external rotation. 64 The reported complications are low tenosynovitis of the long head of biceps and ulnar nerve palsy. 65 Weber osteotomy is used in shoulder instability as a salvage procedure in large engaging Hill-Sachs lesion.…”