The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

Abstract

BackgroundRecurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit.MethodsEngaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging.ResultsThe average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II.ConclusionsCompared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

“…Five patients in the Bankart group experienced recurrent dislocation compared to zero in the combined group. ASES and Rowe score were also significantly better in the combined procedure group [72]. Also, the remplissage group experienced less loss of motion in external rotation and abduction than the isolated Bankart repair group, potentially alleviated concerns of over constraint when addressing engaging HS lesions [72].…”

“…ASES and Rowe score were also significantly better in the combined procedure group [72]. Also, the remplissage group experienced less loss of motion in external rotation and abduction than the isolated Bankart repair group, potentially alleviated concerns of over constraint when addressing engaging HS lesions [72]. As the understanding of bi-polar bone loss continues to evolve, future studies are required to determine the long-term clinical outcomes of patients treated with Bankart repair combined with remplissage.…”

“…The authors found that the addition of remplissage prevented HS engagement in all shoulders with large lesions which were not otherwise stabilized with Bankart repair alone [71]. Ko et al examined the clinical outcomes of concomitant remplissage in patients with engaging HS lesions undergoing Bankart repair [72]. Forty-eight patients with engaging HS lesions underwent surgical stabilization, 24 with Bankart repair alone, and 24 with Bankart combined with remplissage.…”

Dynamic Anterior Stabilization Using the Long Head of the Biceps for Anteroinferior Glenohumeral Instability

“…Remplissage is performed in the presence of humeral head lesions, by tightening the infraspinatus tendon and/or the teres minor muscle 8 and posterior capsule within the defect, rendering it extra-articular. Common complications of remplissage include shoulder stiffness, 15 , 16 , 17 , 18 persistent pain, 11 and failure of tendon healing. 19…”

Arthroscopic Remplissage Using a Double-Pulley System for Hill-Sachs Lesions for Recurrent Shoulder Instability

“…The treatment of choice for patients with anterior shoulder instability is currently the arthroscopic Bankart repair. 1 , 2 , 3 , 4 , 5 , 6 However, even with soft-tissue stabilization surgery, patients with osseous defects in the humeral head, such as Hill-Sachs lesions, are at increased risk for recurrent instability. 1 , 2 , 3 , 4 , 5 , 6 Recurrent instability occurs when the osseous defect in the humeral head engages the glenoid rim and can lead to failure of soft-tissue stabilization surgery.…”