Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair

Horinek, Jeffrey L.; Menendez, Mariano E.; Callegari, Jonathan J.; Narbona, Pablo; Lädermann, Alexandre; Barth, Johannes; Denard, Patrick J.

doi:10.1016/j.asmr.2022.04.004

Cited by 10 publications

(8 citation statements)

References 36 publications

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“…In a comparative study by Miyamoto et al [39], where the percentage of glenoid bone loss was not similar between groups, the rate of recurrent dislocations for the arthroscopic Bankart with remplissage was 0% irrespective of the disparity on glenoid bone loss between groups. Additionally, Horinek et al [46] reported on the recurrent dislocation and revision surgery rate in a comparative study, where the glenoid bone loss and Hill–Sachs lesion size was not comparable between groups. Their results match the results yielded in the present study as they reported a 9.3% and 2.1% recurrent dislocation rate, for isolated Bankart repair and Bankart repair with remplissage, respectively.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

Villarreal‐Espinosa,

Kay,

Ramappa

2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe addition of the remplissage procedure to an arthroscopic Bankart procedure has been shown to improve clinical outcomes, yet at the expense of potentially decreasing shoulder range of motion. The purpose of this study was to assess recurrent instability, range of motion, functional outcomes and rates of return to sport outcomes in patients undergoing an isolated arthroscopic Bankart repair compared to those undergoing arthroscopic Bankart repair in addition to the remplissage procedure.MethodsAccording to the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines, a search was conducted using three databases (MEDLINE/OVID, EMBASE and PubMed). Retrieved studies were screened based on predefined inclusion and exclusion criteria for comparative studies. Data were extracted and meta‐analysis performed using a random‐effects model.ResultsA total of 16 studies (13 level III studies, 2 level II studies and 1 level I) were included with a total of 507 and 704 patients in the Bankart plus remplissage and isolated Bankart repair groups, respectively. No studies reported glenoid bone loss of >20% with the least percentage of glenoid bone loss reported among studies being <1%. There was a significantly increased rate of recurrent dislocations (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.380–7.48, p < 0.00001) and revision procedures (OR = 3.36, 95% CI: 1.52–7.41, p = 0.003) in the isolated Bankart repair group compared to the Bankart plus remplissage group. Additionally, there were no significant differences between groups in terms of external rotation at side (n.s.), in abduction (n.s.) or at forward flexion (n.s.) at final follow‐up. Furthermore, return to preinjury level of sport favoured the Bankart plus remplissage group (OR = 0.54, 95% CI: 0.35–0.85, p = 0.007).ConclusionPatients undergoing arthroscopic Bankart plus remplissage for anterior shoulder instability have lower rates of recurrent instability, higher rates of return to sport, and no significant difference in range of motion at final follow‐up when compared to an isolated arthroscopic Bankart repair. Further large, prospective studies are needed to further determine which patients and degree of bone loss would benefit most from augmentation with the remplissage procedure.Level of EvidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

Villarreal‐Espinosa,

Kay,

Ramappa

2024

Knee surg. sports traumatol. arthrosc.

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“…Nowadays there are many procedures (i.e. revision Bankart repair, remplissage of Hill‐Sachs lesions, arthroscopic subscapularis augmentation, Bristow–Latarjet procedure) available to revise a failed Bankart, depending on the remaining soft tissue and the bipolar bone loss [5, 12, 22]. For athletes with high demand for sports, the Bristow–Latarjet procedure may be an appropriate approach because soft tissue surgery has higher failure rates [4, 18, 24].…”

Section: Discussionmentioning

confidence: 99%

Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer

Song

Zhang

Bai

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose This study aims to determine the rate of diferent levels of return to sports (RTS) in athletes undergoing the modiied arthroscopic Bristow procedure and the factors associated with the level of RTS. MethodsThe study was performed retrospectively on patients with traumatic anterior shoulder instability who underwent the modiied arthroscopic Bristow procedure with a minimum follow-up of 2 years. The RTS rate, the level of return and the timing of return were assessed. Additionally, factors such as preoperative basic information, clinical outcomes, graft position, graft healing and graft absorption were analysed to investigate their correlation with the level of RTS. Multivariate regression models were used to evaluate the factors afecting the level of RTS. Results In total, this study included 182 shoulders of 177 athletes undergoing the modiied arthroscopic Bristow procedure. Of these patients, 142 (78.0%) shoulders of 137 athletes were enrolled, with a mean of 3.3-year follow-up. At the inal follow-up, 134 (94.4%) shoulders were able to RTS, 123 (86.6%) shoulders were able to RTS to the pre-injury level, 52 (36.6%) shoulders could be completely "forgotten" without any psychological barrier during exercise. The multivariate logistic regression analysis identiied the variable associated with RTS at the pre-injury level as previously failed arthroscopic Bankart repair (p < 0.001). As for the "forgetting" operated shoulder, the duration from irst dislocation to surgery was a signiicant independent predictor (p = 0.034). Conclusion Although a large majority of athletes were able to RTS at the pre-injury level after the modiied arthroscopic Bristow procedure, about two-thirds of the athletes felt diference in shoulders on both sides and could not completely "forget" the operated shoulder during exercise. Previously failed Bankart repair and the duration from irst dislocation to surgery were the risk factors associated with the level of RTS after the modiied arthroscopic Bristow procedure. Level of evidence IV.

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“…Despite the fact that more than 90% of the lesions were on-track, remplissage was used in many cases. The rates of recurrence (2.1% vs 9.3%; p 5 0.148), revision (2.1% vs 6.8%: p 5 0.403), and return to sports (83% vs 73%: p 5 0.203) favored remplissage compared with isolated Bankart repair but did not meet statistical significance based on the numbers studied 27 .…”

Section: Table I Calculation Of the Gt Width And Determination Of On-...mentioning

confidence: 94%

“…In a retrospective comparison study of 20 collision athletes with anterior shoulder instability and nonengaging HSLs, Domos et al 25 reported a recurrence rate of 5% at the 26-month follow-up among patients who underwent remplissage compared with 30% in patients who underwent isolated Bankart repair. Horinek et al 27 conducted a retrospective study evaluating 123 patients with recurrent shoulder instability and <15% GBL treated with arthroscopic Bankart repair with and without remplissage. Despite the fact that more than 90% of the lesions were on-track, remplissage was used in many cases.…”

Section: Indicationsmentioning

confidence: 99%

“…Therefore, the As techniques have improved, some authors have expanded indications for arthroscopic remplissage to include patients with on-track HSLs who may be at an increased risk of recurrence. This patient population includes collision athletes or military personnel with a high level of mandatory activity and patients with shoulder hyperlaxity [25][26][27] . In a retrospective comparison study of 20 collision athletes with anterior shoulder instability and nonengaging HSLs, Domos et al 25 reported a recurrence rate of 5% at the 26-month followup among patients who underwent remplissage compared with 30% in patients who underwent isolated Bankart repair.…”

Section: Table I Calculation Of the Gt Width And Determination Of On-...mentioning

confidence: 99%

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Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability

Hwang

Horinek²,

Ardebol

et al. 2022

JBJS Reviews

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A Hill-Sachs lesion (HSL) is a compression fracture on the posterolateral humeral head that can increase the risk of recurrent shoulder instability after isolated arthroscopic Bankart repair.» Remplissage involves capsulotenodesis of the infraspinatus tendon and posterior capsule into the HSL to prevent its engagement with the glenoid rim through extra-articular conversion and restraint against humeral head anterior translation.» The glenoid track concept can be applied preoperatively and intraoperatively to evaluate risk of recurrence and help direct clinical management options for recurrent shoulder instability.» Recent literature supports expanding indications for remplissage to include patients with on-track HSLs who are at increased risk of recurrence including collision athletes, military personal, and patients with joint hyperlaxity.» New techniques and suture constructs have demonstrated improved biomechanical strength while avoiding the need to access the subacromial space.

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Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair

Cited by 10 publications

References 36 publications

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer

Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability

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