Remplissage in Addition to Arthroscopic Bankart Repair for Shoulder Instability With On-Track Hill–Sachs Lesions Reduces Residual Apprehension Without External Rotation Limitation

Abstract

<h3>Purpose</h3> To evaluate the role of remplissage as an adjunct to Bankart repair in patients with recurrent anterior shoulder dislocation combined with on-track Hill–Sachs lesion. <h3>Methods</h3> Arthroscopic Bankart repair with remplissage data (December 2018-2020) were collected (BR group). Inclusion criteria were (1) recurrent anterior shoulder dislocation, (2) on-track Hill–Sachs lesion, (3) minimal/subcritical glenoid bone loss (<17%), and (4) postoperative follow-up >1 year. Exclusion criteria were (1) revision surgery, (2) first dislocation with acute glenoid rim fracture, and (3) combined with other surgery. The control group was identified in Bankart repair–only cohort (B group). All patients were evaluated preoperatively, and at 3 weeks, 6 weeks, 3 months, 6 months, and then annually postoperatively. Visual analogue scale for pain, Self-Assessment Numerical Evaluation, American Shoulder and Elbow Surgeons Shoulder score, ROWE, and Western Ontario Shoulder Instability were evaluated at preoperative and final follow-up. Residual apprehension experience and external rotation deficit were evaluated. Patients, who were followed-up for more than 1 year, were asked how often they experienced any subjective apprehension in 4 grades (1: always, 2: frequently, 3: occasionally, 4: never). Patients who had a history of recurrent dislocation or revision surgery were investigated. <h3>Results</h3> In total, 53 patients (B, 28; BR, 25) were included. At final follow-up, both groups showed improvement in 5 clinical scores postsurgery (<i>P</i> < .001). The BR group showed greater ROWE scores than the B group (B: 75.2 ± 13.6, BR: 84.4 ± 10.8; <i>P</i> = .009). Residual apprehension patient ratio (B: 71.4% [20/28], BR: 32% [8/25]; <i>P</i> = .004) and the mean subjective apprehension grade (B: 3.1 ± 0.6, BR: 3.6 ± 0.6; <i>P</i> = .005) showed statistically significant difference, whereas no patients in either group experienced external rotation deficit (B: 14.8 ± 12.9°, BR: 18.0 ± 15.2°, <i>P</i> = .420). Only 1 patient in the B group had not responded to surgery, with dislocation recurrence (<i>P</i> = .340). <b>Conclusions</b>: Remplissage with arthroscopic Bankart repair in on-track Hill–Sachs lesion has a role in reducing residual apprehension without external rotation limitation. <h3>Level of Evidence</h3> Level III, retrospective comparative therapeutic trial.