Consideration May Be Given to Lowering the Threshold for the Addition of Remplissage in Patients With Subcritical Glenoid Bone Loss Undergoing Arthroscopic Bankart Repair

Abstract

PurposeTreatment for patients with anterior glenohumeral instability with subcritical bone loss is evolving. The purpose of this study was to compare 2-year outcomes of arthroscopic Bankart repair with and without Hill–Sachs remplissage in patients with <15% glenoid bone loss.MethodsA multicenter retrospective study was performed on a consecutive series of patients who underwent primary isolated arthroscopic Bankart repair (IBR) or arthroscopic Bankart repair with remplissage (REMP) by 4 shoulder specialists between 2013 and 2019. Range of motion (ROM) and patient-reported outcomes (PROs) were collected at baseline and 2 years postoperative: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Recurrence, return to sport, satisfaction, complications, and revisions also were reviewed.ResultsA total of 123 patients were available, including 75 IBR and 48 REMP. Baseline demographics, activity, ROM, and PROs were similar. Mean glenoid bone loss (2.5% vs 6.1%: P < .001) was greater in REMP, although the number of on-track lesions was similar (98.7% vs 93.8%: P = .298). WOSI scores were improved for REMP (196.5 vs 42.7: P = .004), but otherwise no difference in postoperative PROs or ROM. Differences between cohorts did not reach significance in return to sport (73% vs 83%: P = .203), recurrence (9.3% vs 2.1%: P = .148), or revisions (6.8% vs 2.1%: P = .403). For on-track lesions there were 6 recurrences in IBR (6 of 74; 8.1%) and 1 recurrence in REMP (1 of 45; 2.2%).ConclusionsDespite slightly worse pathology, patients with subcritical bone loss who undergo REMP experience similar short-term postoperative function to isolated IBR. Recurrence, revision, and return to sport favored REMP but this study was underpowered to show statistical significance. Recurrence was common following IBR, despite subcritical glenoid bone loss and primarily on-track lesions, suggesting that REMP can be considered in on-track lesions.Level of EvidenceIII, retrospective comparative study.