Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability.

Abstract

Purpose:We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation.Methods:Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively.Results: Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up.Conclusion: Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.