Introduction
The treatment of recurrent anterior glenohumeral instability is complicated when there are bony defects present on either the humeral or glenoid side. Several studies have documented poor outcomes with arthroscopic Bankart repair when sizable defects are encountered at arthroscopy. The following investigation seeks to determine whether Arthroscopic Remplissage with Bankart repair is an effective treatment strategy for patients with both glenoid bone loss and engaging Hill Sachs defects.
Methods
Between 2005 and 2008, 23 patients underwent Arthroscopic Bankart Repair with Remplissage for the treatment of recurrent anterior glenohumeral instability and large Hill Sachs defects. At arthroscopy all patients were found to have both erosion of the anterior glenoid and an associated engaging Hill Sachs defect. Patients were followed post-operatively with the Western Ontario Shoulder Instability Score (WOSI), the American Shoulder and Elbow Society Score, and the PENN Shoulder Score. Recurrent subluxation or dislocation was documented.
Results
Of 23 patients, 18 were male and 5 were female. The average age of the patients was 24.4 years. The average length of follow-up in this series was 24.4 months. At final follow-up, only 1 patient reported a recurrence of instability and this was documented as a dislocation requiring closed reduction. The average ASES score was 82.4/100 (Pain 46.4; Function 36.1). The average PENN score was 90.1/100 (Pain 27.3/30; Satisfaction 8.7/10; Function 54.1/60). The average total WOSI score was 514 (75%); physical symptom score was 206.5; work/sports score was 109; lifestyle score was 84; emotional score was 114.5.
Conclusion
Arthroscopic Remplissage with Bankart Repair was successful at restoring stability in the majority of patients with recurrent glenohumeral instability with large Hill Sachs lesions. This all arthroscopic technique yielded excellent patient satisfaction and compared favorably to historic results for patients with bone lesions.
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Copyright
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
