Management of an engaging Hill–Sachs lesion: arthroscopic remplissage with Bankart repair versus Latarjet procedure

Abstract

Case-control study, Level III.

Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

“…3 In patients with on-track lesions, the combination of a Bankart repair with a remplissage procedure will typically provide adequate stability and yield good clinical results. 7,8 However, the combination of both procedures was found to significantly reduce the range of glenohumeral rotation. 7 In a current concepts paper, Di Giacomo, Itoi, and Burkhart suggest that in patients with off-track lesions and glenoid bone loss of less than 25%, the combination of Bankart repair with remplissage is indicated.…”

“…The treatment of patients with BBL and AGI remains challenging, and the proper treatment needs to be determined for each individual patient as no clear guidelines exist on how to address patients with BBL with varying degrees of bone loss. 1,2,8,10 The on-track/off-track principle is helpful to determine whether multiple surgical interventions are necessary at the time of treatment to restore glenohumeral stability. 3 In patients with on-track lesions, the combination of a Bankart repair with a remplissage procedure will typically provide adequate stability and yield good clinical results.…”

“…6,8 However, Mook et al recently found that the risk for recurrent instability after the Latarjet procedure is increased in patients with predicted off-track BBL, even after a Latarjet. The prediction is performed by preoperatively calculating how much the glenoid arc will be lengthened after the coracoid is transferred.…”

“…In patients with anterior glenoid deficiency of less than 25%, a combination of an anterior Bankart procedure and posterior remplissage is recommended. [6][7][8] If the anterior glenoid bone loss exceeds 25% of the anteroposterior expansion, the Latarjet procedure alone is usually indicated. 6,8 In "borderline" cases with distinct BBL of both the glenoid and the humeral head, the combination of a Bankart procedure and a remplissage can severely reduce the capsular volume and restrict the range of glenohumeral motion, especially the range of rotation.…”

“…[6][7][8] If the anterior glenoid bone loss exceeds 25% of the anteroposterior expansion, the Latarjet procedure alone is usually indicated. 6,8 In "borderline" cases with distinct BBL of both the glenoid and the humeral head, the combination of a Bankart procedure and a remplissage can severely reduce the capsular volume and restrict the range of glenohumeral motion, especially the range of rotation. 7 As Mook et al have shown, in cases with more severe BBL treated with the Latarjet procedure alone, the humeral head can still be off-track if the Hill-Sachs lesion is not addressed.…”