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Remplissage in addition to arthroscopic Bankart repair for shoulder instability with on-track Hill-Sachs lesions reduces residual apprehension without external rotation limitation

  • Author Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    ,
    Author Footnotes
    † First Authors: Woojin Yu, MD, and Hyojune Kim, MD
    Woojin Yu
    Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    † First Authors: Woojin Yu, MD, and Hyojune Kim, MD
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  • Author Footnotes
    2 Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, EuUniversity lji University School of Medicine, Daejeon, Republic of Korea
    ,
    Author Footnotes
    † First Authors: Woojin Yu, MD, and Hyojune Kim, MD
    Hyojune Kim
    Footnotes
    2 Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, EuUniversity lji University School of Medicine, Daejeon, Republic of Korea
    † First Authors: Woojin Yu, MD, and Hyojune Kim, MD
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  • Jeong-Hyeon Seo
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  • Author Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    In-Ho Jeon
    Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    Kyoung Hwan Koh
    Correspondence
    Corresponding Author: Kyoung Hwan Koh, MD, PhD, Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05535, Republic of Korea, Tel: +82-2-3010-3530, Fax: +82-2-2045-4542
    Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 Department of Orthopaedic Surgery, Asan Medical Center, of Ulsan College of Medicine, Seoul, Republic of Korea
    2 Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, EuUniversity lji University School of Medicine, Daejeon, Republic of Korea
    † First Authors: Woojin Yu, MD, and Hyojune Kim, MD
Published:October 27, 2022DOI:https://doi.org/10.1016/j.arthro.2022.10.013

      Abstract

      Purpose

      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.

      Methods

      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 (PVAS), Self-Assessment Numerical Evaluation (SANE), American Shoulder and Elbow Surgeons Shoulder (ASES) score, ROWE, and Western Ontario Shoulder Instability (WOSI) 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.

      Results

      53 patients (B, 28; BR, 25) were included. At final follow-up, both groups showed improvement in 5 clinical scores postsurgery (P < 0.001). The BR group showed higher ROWE scores than the B group (B: 75.2 ± 13.6, BR: 84.4 ± 10.8; P = 0.009). Residual apprehension patient ratio (B: 71.4% (20/28), BR: 32% (8/25); P = 0.004) and the mean subjective apprehension grade (B: 3.1 ± 0.6, BR: 3.6 ± 0.6; P = 0.005) showed statistically significant difference, while no patients in either group experienced external rotation deficit (B: 14.8 ± 12.9°, BR: 18.0 ± 15.2°, P = 0.420). Only one B group patient had failed surgery with dislocation recurrence (p =.340).

      Conclusions

      Remplissage with arthroscopic Bankart repair in on-track Hill-Sachs lesion has a role in reducing residual apprehension without external rotation limitation.

      Keywords

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