Arthroscopic Bankart Repair With Remplissage in Comparison to Bone Block Augmentation for Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review

Published:September 06, 2020DOI:


      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.


      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.


      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.


      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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        • Cutts S.
        • Prempeh M.
        • Drew S.
        Anterior shoulder dislocation.
        Ann R Coll Surg Engl. 2009; 91: 2-7
        • Zacchilli M.A.
        • Owens B.D.
        Epidemiology of shoulder dislocations presenting to emergency departments in the United States.
        J Bone Joint Surg Am. 2010; 92: 542-549
        • Leroux T.
        • Wasserstein D.
        • Veillette C.
        • et al.
        Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada.
        Am J Sports Med. 2014; 42: 442-450
        • Vermeiren J.
        • Handelberg F.
        • Casteleyn P.P.
        • Opdecam P.
        The rate of recurrence of traumatic anterior dislocation of the shoulder—A study of 154 cases and a review of the literature.
        Int Orthop. 1993; 17: 337-341
        • Larrain M.V.
        • Botto G.J.
        • Montenegro H.J.
        • Mauas D.M.
        Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes.
        Arthroscopy. 2001; 17: 373-377
        • Brophy R.H.
        • Marx R.G.
        Osteoarthritis following shoulder instability.
        Clin Sports Med. 2005; 24: 47-56
        • Shanley E.
        • Thigpen C.
        • Brooks J.
        • et al.
        Return to sport as an outcome measure for shoulder instability: Surprising findings in nonoperative management in a high school athlete population.
        Am J Sports Med. 2019; 47: 1062-1067
        • Hill H.A.
        • Sachs M.D.
        The grooved defect of the humeral head.
        Radiology. 1940; 35: 690-700
        • Calandra J.J.
        • Baker C.L.
        • Uribe J.
        The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations.
        Arthroscopy. 1989; 5: 254-257
        • Griffith J.F.
        • Antonio G.E.
        • Yung P.S.H.
        • et al.
        Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients.
        Am J Roentgenol. 2008; 190: 1247-1254
        • Burkhart S.S.
        • De Beer J.F.
        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
        • Spatschil A.
        • Landsiedl F.
        • Anderl W.
        • et al.
        Posttraumatic anterior-inferior instability of the shoulder: Arthroscopic findings and clinical correlations.
        Arch Orthop Trauma Surg. 2006; 126: 217-222
        • Edwards T.B.
        • Boulahia A.
        • Walch G.
        Radiographic analysis of bone defects in chronic anterior shoulder instability.
        Arthroscopy. 2003; 19: 732-739
        • Rowe C.R.
        • Patel D.
        • Southmayd W.W.
        The Bankart procedure. A long-term end-result study.
        J Bone Joint Surg Am. 1978; 60: 1-16
        • Čičak N.
        • Bilić R.
        • Delimar D.
        Hill-Sachs lesion in recurrent shoulder dislocation: Sonographic detection.
        J Ultrasound Med. 1998; 17: 557-560
        • Nakagawa S.
        • Ozaki R.
        • Take Y.
        • Iuchi R.
        • Mae T.
        Relationship between glenoid defects and Hill-Sachs lesions in shoulders with traumatic anterior instability.
        Am J Sports Med. 2015; 43: 2763-2773
        • Yiannakopoulos C.K.
        • Mataragas E.
        • Antonogiannakis E.
        A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability.
        Arthroscopy. 2007; 23: 985-990
        • Balg F.
        • Boileau P.
        The instability severity index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.
        J Bone Joint Surg Br. 2007; 89: 1470-1477
        • Voos J.E.
        • Livermore R.W.
        • Feeley B.T.
        • et al.
        Prospective evaluation of arthroscopic bankart repairs for anterior instability.
        Am J Sports Med. 2010; 38: 302-307
        • Boileau P.
        • Villalba M.
        • Héry J.Y.
        • Balg F.
        • Ahrens P.
        • Neyton L.
        Risk factors for recurrence of shoulder instability after arthroscopic bankart repair.
        J Bone Joint Surg Am. 2006; 88: 1755-1763
        • Kralinger F.S.
        • Golser K.
        • Wischatta R.
        • Wambacher M.
        • Sperner G.
        Predicting recurrence after primary anterior shoulder dislocation.
        Am J Sports Med. 2002; 30: 116-120
        • Cetik O.
        • Uslu M.
        • Ozsar B.K.
        The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation.
        Acta Orthop Belg. 2007; 73: 175-178
        • Fox J.A.
        • Sanchez A.
        • Zajac T.J.
        • Provencher M.T.
        Understanding the Hill-Sachs lesion in its role in patients with recurrent anterior shoulder instability.
        Curr Rev Musculoskelet Med. 2017; 10: 469-479
        • Di Giacomo G.
        • Itoi E.
        • Burkhart S.S.
        Evolving concept of bipolar bone loss and the HILL-SAChs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion.
        Arthroscopy. 2014; 30: 90-98
        • Arciero R.A.
        • Parrino A.
        • Bernhardson A.S.
        • et al.
        The effect of a combined glenoid and Hill-Sachs defect on glenohumeral stability: A biomechanical cadaveric study using 3-dimensional modeling of 142 patients.
        Am J Sports Med. 2015; 43: 1422-1429
        • Lynch J.R.
        • Clinton J.M.
        • Dewing C.B.
        • Warme W.J.
        • Matsen F.A.
        Treatment of osseous defects associated with anterior shoulder instability.
        J Shoulder Elb Surg. 2009; 18: 317-328
        • Lo I.K.Y.
        • Parten P.M.
        • Burkhart S.S.
        The inverted pear glenoid: An indicator of significant glenoid bone loss.
        Arthroscopy. 2004; 20: 169-174
        • Itoi E.
        • Lee S.B.
        • Berglund L.J.
        • Berge L.L.
        • An K.N.
        The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study.
        J Bone Joint Surg Am. 2000; 82: 35-46
        • Bigliani L.U.
        • Newton P.M.
        • Steinmann S.P.
        • Connor P.M.
        • McIlveen S.J.
        Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder.
        Am J Sports Med. 1998; 26: 41-45
        • Yamamoto N.
        • Itoi E.
        • Abe H.
        • et al.
        Effect of an anterior glenoid defect on anterior shoulder stability: A cadaveric study.
        Am J Sports Med. 2009; 37: 949-954
        • Chen A.L.
        • Hunt S.A.
        • Hawkins R.J.
        • Zuckerman J.D.
        Management of bone loss associated with recurrent anterior glenohumeral instability.
        Am J Sports Med. 2005; 33: 912-925
        • Shin S.J.
        • Koh Y.W.
        • Bui C.
        • et al.
        What is the critical value of glenoid bone loss at which soft tissue Bankart repair does not restore glenohumeral translation, restricts range of motion, and leads to abnormal humeral head position?.
        Am J Sports Med. 2016; 44: 2784-2791
        • Shin S.J.
        • Kim R.G.
        • Jeon Y.S.
        • Kwon T.H.
        Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair.
        Am J Sports Med. 2017; 45: 1975-1981
        • Shaha J.S.
        • Cook J.B.
        • Song D.J.
        • et al.
        Redefining “critical” bone loss in shoulder instability.
        Am J Sports Med. 2015; 43: 1719-1725
        • DIckens J.F.
        • Owens B.D.
        • Cameron K.L.
        • et al.
        The effect of subcritical bone loss and exposure on recurrent instability after arthroscopic bankart repair in intercollegiate American football.
        Am J Sports Med. 2017; 45: 1769-1775
        • Miniaci A.
        • Gish M.W.
        Management of anterior glenohumeral instability associated with large Hill-Sachs defects.
        Tech Shoulder Elb Surg. 2004; 5: 170-175
        • Purchase R.J.
        • Wolf E.M.
        • Hobgood E.R.
        • Pollock M.E.
        • Smalley C.C.
        Hill-Sachs ‘remplissage’: An arthroscopic solution for the engaging Hill-Sachs lesion.
        Arthroscopy. 2008; 24: 723-726
        • Bokshan S.L.
        • DeFroda S.F.
        • Owens B.D.
        Comparison of 30-day morbidity and mortality after arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures: A review of 2864 cases.
        Orthop J Sport Med. 2017; 5
        • Yang J.S.
        • Mehran N.
        • Mazzocca A.D.
        • Pearl M.L.
        • Chen V.W.
        • Arciero R.A.
        Remplissage versus modified Latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss.
        Am J Sports Med. 2018; 46: 1885-1891
        • Shah A.A.
        • Butler R.B.
        • Romanowski J.
        • Goel D.
        • Karadagli D.
        • Warner J.J.P.
        Short-term complications of the Latarjet procedure.
        J Bone Joint Surg Am. 2012; 94: 495-501
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015; 4: 1-9
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (Minors): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Higgins J.P.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        Cochrane bias methods group; Cochrane statistical methods group. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159
        • Park I.
        • Oh M.J.
        • Shin S.J.
        Minimal clinically important differences and correlating factors for the rowe score and the American shoulder and elbow surgeons score after arthroscopic stabilization surgery for anterior shoulder instability.
        Arthroscopy. 2019; 35: 54-59
        • Brilakis E.
        • Mataragas E.
        • Deligeorgis A.
        • Maniatis V.
        • Antonogiannakis E.
        Midterm outcomes of arthroscopic remplissage for the management of recurrent anterior shoulder instability.
        Knee Surg Sport Traumatol Arthrosc. 2016; 24: 593-600
        • Bah A.
        • Lateur G.M.
        • Kouevidjin B.T.
        • et al.
        Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure.
        Orthop Traumatol Surg Res. 2018; 104: 17-22
        • Cho N.S.
        • Yoo J.H.
        • Rhee Y.G.
        Management of an engaging Hill-Sachs lesion: Arthroscopic remplissage with Bankart repair versus Latarjet procedure.
        Knee Surg Sport Traumatol Arthrosc. 2016; 24: 3793-3800
        • Abouelsoud M.M.
        • Abdelrahman A.A.
        Recurrent anterior shoulder dislocation with engaging Hill-Sachs defect: Remplissage or Latarjet?.
        Eur Orthop Traumatol. 2015; 6: 151-156
        • Bastard C.
        • Herisson O.
        • Gaillard J.
        • Nourissat G.
        Impact of remplissage on global shoulder outcome: A long-term comparative study.
        Arthroscopy. 2019; 35: 1362-1367
        • Torg J.S.
        • Balduini F.C.
        • Bonci C.
        • et al.
        A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.
        J Bone Joint Surg Am. 1987; 69: 904-913
        • Ekhtiari S.
        • Horner N.S.
        • Bedi A.
        • Ayeni O.R.
        • Khan M.
        The learning curve for the Latarjet procedure: A systematic review.
        Orthop J Sport Med. 2018; 6 (2325967118786930)
        • Gupta A.
        • Delaney R.
        • Petkin K.
        • Lafosse L.
        Complications of the Latarjet procedure.
        Curr Rev Musculoskelet Med. 2015; 8: 59-66
        • Hovelius L.
        • Sandström B.
        • Olofsson A.
        • Svensson O.
        • Rahme H.
        The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study III): Long-term follow-up in 319 shoulders.
        J Shoulder Elb Surg. 2012; 21: 647-660
        • Lädermann A.
        • Denard P.J.
        • Burkhart S.S.
        Injury of the suprascapular nerve during latarjet procedure: An anatomic study.
        Arthroscopy. 2012; 28: 316-321
        • Clavert P.
        • Lutz J.C.
        • Wolfram-Gabel R.
        • Kempf J.F.
        • Kahn J.L.
        Relationships of the musculocutaneous nerve and the coracobrachialis during coracoid abutment procedure (Latarjet procedure).
        Surg Radiol Anat. 2009; 31: 49-53
        • Metais P.
        • Clavert P.
        • Barth J.
        • et al.
        Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases.
        Orthop Traumatol Surg Res. 2016; 102: S271-S276
        • Xu J.
        • Liu H.
        • Lu W.
        • et al.
        Clinical outcomes and radiologic assessment of a modified suture button arthroscopic Latarjet procedure.
        BMC Musculoskelet Disord. 2019; 20: 173
        • do Nascimento A.T.
        • Claudio G.
        • vo K.
        • Rocha P.B.
        • Zumárraga J.P.
        • de Camargo O.P.
        Arthroscopic latarjet technique combined with endobuttons: Functional outcomes in 26 cases.
        Acta Ortop Bras. 2018; 26: 328-331
        • Boileau P.
        • Gendre P.
        • Baba M.
        • et al.
        A guided surgical approach and novel fixation method for arthroscopic Latarjet.
        J Shoulder Elb Surg. 2016; 25: 78-89
        • Shaha J.S.
        • Cook J.B.
        • Song D.J.
        • et al.
        ‘Subcritical’ glenoid bone loss increases redislocation rates in primary arthroscopic Bankart repair.
        Orthop J Sport Med. 2014; 2 (2325967114S00025)
        • Lansdown D.A.
        • Wang K.
        • Yanke A.B.
        • Nicholson G.P.
        • Cole B.J.
        • Verma N.N.
        A flat anterior glenoid corresponds to subcritical glenoid bone loss.
        Arthroscopy. 2019; 35: 1788-1793
        • Garcia G.H.
        • Park M.J.
        • Zhang C.
        • Kelly J.D.
        • Huffman G.R.
        Large Hill-Sachs lesion: A comparative study of patients treated with arthroscopic Bankart repair with or without remplissage.
        HSS J. 2015; 11: 98-103
        • Degen R.M.
        • Giles J.W.
        • Johnson J.A.
        • Athwal G.S.
        Remplissage versus Latarjet for engaging Hill-Sachs defects without substantial glenoid bone loss: A biomechanical comparison.
        Clin Orthop Rel Res. 2014; 472: 2363-2371