Arthroscopic Bankart Repair and Remplissage in Patients with Combined Humeral and Glenoid Bone Loss

Abstract

To evaluate the efficacy of combined arthroscopic Bankart repair and remplissage, with particular focus on the effect of increasing of bone loss on (1) recurrent instability and (2) patient-derived outcomes. Fifty-five patients who underwent arthroscopic Bankart repair and remplissage during a 4.5- year period were retrospectively identified. The medical record was reviewed for factors potentially associated with failure. Pre-operative glenoid and humeral head bone loss was calculated using established MRI-based measurement techniques. Outcomes of interest included recurrent instability, Western Ontario Shoulder Instability (WOSI) scores, return to pre-injury activity level, pain level (0-5), and patient satisfaction. Forty-five of 53 eligible cases (85%) with mean age 30.1 years participated at mean follow-up of 38 months (range:18-65). Three cases of recurrent instability were identified among participating patients and 2 additional cases were documented in record review of the others (10.6%(5/47)). While bone loss was greater in patients with recurrence compared to those who remained stable, differences were not statistically significant (glenoid:19.3%-vs-14.4%, p=0.19; humeral:41.6%-vs-39.2%, p=0.60). Subgroup analysis, however, revealed a trend toward a higher recurrence rate in patients with >20% glenoid bone loss (vs 0.05). Fewer remplissage sutures were used in patients with recurrence (2.4+/-0.9-vs- 3.9+/-1.6, p=0.04). Mean postoperative WOSI score was 74%. Mean pain scores improved from 2.4 preoperatively to 1.0 postoperatively (p=0.001), 62% of patients returned to pre-injury activity level, and 95% were satisfied. Combined arthroscopic Bankart repair and remplissage results in an acceptable rate of recurrent instability, good functional scores, improved pain, and high satisfaction rates in patients with significant Hill-Sachs defects and mild to moderate bone loss.