Purpose
To determine whether arthroscopic remplissage with Bankart repair is an effective
treatment strategy for patients with Bankart lesions and large Hill-Sachs defects.
Methods
Between 2006 and 2008, 20 patients underwent arthroscopic Bankart repair with remplissage
for the treatment of recurrent anterior glenohumeral instability and large Hill-Sachs
defects. Preoperative imaging in all patients identified avulsion of the anterior
inferior glenohumeral ligament with an associated Hill-Sachs defect that involved
greater than 25% of the humeral head. Patients were followed up postoperatively with
the Western Ontario Shoulder Instability score, the American Shoulder and Elbow Surgeons
score, and the Penn Shoulder Score. Recurrent subluxation or dislocation was documented.
Results
There were 15 male patients and 5 female patients. The mean age of the patients was
27.3 years. The mean length of follow-up in this series was 29.2 months (range, 24.3
to 37.7 months). At final follow-up, 3 patients reported recurrence of instability,
which spontaneously reduced in all cases. The mean American Shoulder and Elbow Surgeons
score was 92.5 (pain, 47.3; function, 45.3). The mean Penn score was 90 of 100 (pain,
27.3 of 30; satisfaction, 8.5 of 10; function, 54.3 of 60). The mean total Western
Ontario Shoulder Instability score was 72.74% (mean physical symptom score, 77.10%;
mean sports and recreation score, 70.25%; mean lifestyle score, 75%; mean emotions
score, 58.50%).
Conclusions
Using an all-arthroscopic remplissage technique with Bankart repair, we were able
to restore function, diminish pain, and yield satisfaction in 85% of the patients
in this study. Our results compare favorably with historic controls with similar pathology
at early- to intermediate-term follow-up in terms of recurrence.
Level of Evidence
Level IV, therapeutic case series.
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References
- Treatment of osseous defects associated with anterior shoulder instability.J Shoulder Elbow Surg. 2009; 18: 317-328
- The grooved defect of the humeral head: A frequently unrecognized complication of dislocations of the shoulder joint.Radiology. 1940; 35: 690-700
- Recurrent anterior dislocation of the shoulder after surgical repair.J Bone Joint Surg Am. 1984; 66: 159-168
- Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion.Arthroscopy. 2000; 16: 677-694
- Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft.Am J Sports Med. 2006; 34: 205-212
- Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder.J Bone Joint Surg Am. 1998; 80: 841-852
- Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss.Arthroscopy. 2007; 23: 1033-1041
- Osteoarticular allograft transplantation for large humeral head defects in glenohumeral instability.Arthroscopy. 2007; 23: 322.e1-322.e5
- Humeral head defects associated with shoulder dislocations: Their diagnostic and surgical significance.Instr Course Lect. 1972; 21: 42-54
- Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft.Arthroscopy. 2009; 25: 446-452
- Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair.J Bone Joint Surg Am. 2006; 88: 1755-1763
- Arthroscopic shoulder stabilization: Is there ever a need to open?.Arthroscopy. 2007; 23: 779-784
- Arthroscopic Latarjet procedure.J Shoulder Elbow Surg. 2010; 19: 2-12
- Hill-Sachs “remplissage”: An arthroscopic solution for the engaging Hill-Sachs lesion.Arthroscopy. 2008; 24: 723-726
- Quantifying glenoid bone loss arthroscopically in shoulder instability.Arthroscopy. 2002; 18: 488-491
- Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation.Arch Orthop Trauma Surg. 2009; 129: 1327-1334
- Revision arthroscopic capsulolabral reconstruction for recurrent instability of the shoulder.J Bone Joint Surg Br. 2008; 90: 1462-1467
- Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation.ANZ J Surg. 2006; 76: 436-438
- Treatment of recurrent dislocation of the shoulder.Lyon Chir. 1954; 49 (in French): 994-997
- Articular arc length mismatch as a cause of failed Bankart repair.Arthroscopy. 2000; 16: 740-744
- Bristow-Latarjet repairs for anterior instability of the shoulder: Clinical and radiographic results at mean 8.2 years follow-up.Chir Main. 2008; 27 (in French): 26-30
- Osteochondral allograft transplantation for treatment of glenohumeral instability.Arthroscopy. 2005; 21: 1007.e1-1007.e4
- Combined glenoid and humeral head allograft reconstruction for recurrent anterior glenohumeral instability.Orthopedics. 2008; 31: 497
- Arthroscopic filling of Hill-Sachs lesions.Arthroscopy. 2007; 23 (Abstr): e2
- Recurrent anterior instability following failed surgical repair: Allograft reconstruction of large humeral head defects.J Bone Joint Surg Br. 2001; 83: 19-20
- Transhumeral head plasty for large Hill-Sachs lesions.Arthroscopy. 2006; 22: 798.e1-798.e4
- Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion.J Bone Joint Surg Am. 1984; 66: 1443-1450
- Arthroscopic and open Bankart repairs provide similar outcomes.Clin Orthop Relat Res. 2006; 446: 227-232
- The Bankart procedure: A long-term end-result study.J Bone Joint Surg Am. 1978; 60: 1-16
- Bony instability of the shoulder.Arthroscopy. 2008; 24: 1061-1073
- Decreased range of motion following arthroscopic remplissage.Orthopedics. 2008; 31: 492
- Remplissage: Infraspinatus tenodesis and posterior capsulodesis for the treatment of Hill Sachs lesions: An all intraarticular technique.Tech Shoulder Elbow Surg. 2008; 4: 188-192
- Hill-Sachs defects and repair using osteoarticular allograft transplantation: Biomechanical analysis using a joint compression model.Am J Sports Med. 2009; 37: 2459-2466
Article info
Publication history
Published online: August 08, 2011
Accepted:
May 12,
2011
Received:
July 22,
2010
Footnotes
Research was performed at the University of Pennsylvania and Temple University. The authors report no conflict of interest.
Note: To access the video accompanying this report, visit the September issue of Arthroscopy at www.arthroscopyjournal.org.
Identification
Copyright
© 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.