Long‐term outcome of arthroscopic remplissage in addition to the classic Bankart repair for the management of recurrent anterior shoulder instability with engaging Hill–Sachs lesions

• DOI: 10.1007/s00167-018-5261-3
• Publication Date: 2018-10-29T09:10:49Z
• Authors: Emmanouil Brilakis; Grigoris Avramidis; Michael‐Alexander...; Apostolos Stathellis; Anastasios Delige...; Ioannis Chiotis; Elias Mataragas; Efstathios Chrono...; Emmanouil Antonog...
• Keywords: Adult; Joint Instability; Male; Shoulder; Adolescent; Shoulder Joint; Shoulder Dislocation; Tenodesis; Middle Aged; Arthroplasty; Arthroscopy; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Recurrence; Bankart Lesions; Secondary Prevention; Humans; Female; Range of Motion, Articular; Retrospective Studies

AbstractPurposeThe evaluation of the long‐term outcome of the arthroscopic remplissage performed in addition to the classic Bankart repair for the primary management of recurrent anterior shoulder instability with engaging Hill–Sachs lesion without inverted pear appearance of the glenoid during arthroscopy.MethodsDuring a 6‐year period, from 2007 to 2012, 65 patients whose average age was 30.1 ± 7.6 years were operated on in our department and satisfied the inclusion criteria of this study. They all had a positive apprehension sign preoperatively. Among them, 51 patients (82%) were available for long‐term evaluation. The mean follow‐up period was 8.1 ± 1.8 years (range 5.6–10.6).ResultsThree patients (5.6%) had suffered a new dislocation. The remaining patients (94.4%) were satisfied with the surgical result and returned to their previous daily activities, whereas 71% continued to participate in sports without restrictions. The ASES score increased from 72.5 (range 18–100) preoperatively to 100 (range 85–100) postoperatively (p < 0.01). The modified Rowe score increased from 40 (range 15–70) to 100 (range 70–100) (p < 0.001), and the Oxford Instability score from 29 (range 9–47) to 48 (range 36–48) (p < 0.001). No significant restriction in the shoulder range of motion was documented.ConclusionsThe combination of the arthroscopic remplissage with the classic Bankart repair was proven to be a safe and effective procedure for the treatment of “engaging” Hill–Sachs lesions without inverted pear appearance of the glenoid. This combination has long‐term outcomes in terms of the recurrence rate and does not significantly influence the range of motion of the shoulder.Level of evidenceTherapeutic Study—Case series with no comparison group, Level IV.