Mid-term results of arthroscopic Bankart repair and remplissage for recurrent anterior shoulder instability in patients with a history of seizures

Mohammad Reza Guity,Amir Sobhani Eraghi

doi:10.1186/s12891-021-04960-9

Abstract

BackgroundSeizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures.MethodsIn this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score.ResultsThe mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5).ConclusionIn patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.

Highlights

The shoulder joints are considered the most commonly dislocated joint in the human body, comprising up to 50% of all human joint dislocations [1]
Guity and Sobhani Eraghi BMC Musculoskeletal Disorders (2022) 23:12 treatment of shoulder dislocation is a minimally invasive approach that has significantly evolved over the last decades and offers encouraging results with several advantages over the open surgical treatment, including a decreased rate of morbidity, early functional rehabilitation, improved range of motion, less hospital stay, and lower costs [3]
The most common surgical procedure for the treatment of recurrent anterior shoulder instability is arthroscopic Bankart repair, but some factors such as young age, sportive activities, and glenoid defects may result in a high failure rate, and patients with these characteristics could benefit from open surgery or arthroscopic anterior bone block procedures

Summary

Introduction

The shoulder joints are considered the most commonly dislocated joint in the human body, comprising up to 50% of all human joint dislocations [1]. The most common surgical procedure for the treatment of recurrent anterior shoulder instability is arthroscopic Bankart repair, but some factors such as young age, sportive activities, and glenoid defects may result in a high failure rate, and patients with these characteristics could benefit from open surgery or arthroscopic anterior bone block procedures. Shoulder dislocation in the context of seizures is highly prone to recurrence. This is due to the severity of initial pathologies, especially huge defects of the humeral head and glenoid. We report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures

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