Purpose
The purpose of this systematic review is to examine the rates of postoperative recurrence
of instability, functional outcomes, and complications after treatment with bone augmentation
procedures or arthroscopic Bankart repair with remplissage for recurrent anterior
shoulder instability in the setting of subcritical glenoid bone loss.
Methods
EMBASE, PubMed, and MEDLINE were searched from database inception until June 2019
for articles examining either bone block augmentation to the glenoid or Bankart repair
with remplissage (BRR) in the setting of subcritical glenoid bone loss. Search and
data extraction were performed by 2 reviewers independently and in duplicate. A separate
analysis was done for comparative studies.
Results
Overall, 145 studies were identified, including 4 comparative studies. Across all
studies, postoperative recurrence rates ranged from 0% to 42.8% for bone block augmentation
and 0% to 15% for Bankart repair with remplissage. In comparative studies reporting
subcritical glenoid bone loss, rates were 5.7% to 11.6% in the Latarjet group and
0% to 13.3% in the Bankart repair with remplissage group. However, in all studies
reporting 10% to 15% mean glenoid bone loss, there was an increased rate of recurrent
instability with arthroscopic soft tissue repair (6.1% to 13.2%) in comparison with
bony augmentation (0% to 8.2%). Lastly, complication rates ranged from 0% to 66.7%
for the bone block group and 0% to 2.3% for arthroscopic Bankart repair with remplissage.
Conclusion
Both bone block augmentation and Bankart repair with remplissage are effective treatment
options for recurrent anterior shoulder instability in patients with bipolar bone
loss but subcritical glenoid bone loss. Both have comparable functional outcomes,
albeit bone block procedures carry an increased risk of complications. Arthroscopic
BRR may be associated with a higher failure rate for preoperative glenoid bone loss
>10%. Therefore, it may represent a stabilization procedure best suited for cases
of recurrent anterior instability with glenoid bone loss <10% and the presence of
a significant, off-track Hill-Sachs lesion.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
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Article info
Publication history
Published online: September 06, 2020
Accepted:
August 21,
2020
Received:
March 17,
2020
>See commentary on page 718Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
