Arthroscopic Bankart Repair With Hill-Sachs Remplissage Shows Low Recurrence and Excellent Outcomes for Primary and Revision Surgery at Midterm Follow-Up.

Abstract

Purpose: To assess midterm outcomes, including recurrence and patient-reported measures, after arthroscopic Bankart repair with remplissage in both primary and revision cases.

Methods: A retrospective, single-surgeon review was performed on patients who underwent arthroscopic Bankart repair with remplissage between 2012 and 2016 with a minimum 7-year follow-up. The primary outcome was self-reported recurrence of anterior instability (subluxation or dislocation). Secondary outcomes included Western Ontario Shoulder Instability Index, range of motion, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and pain rating.

Results: Of the 22 eligible patients, 13 (59%) with a mean of 13 preoperative instability events were included (10 primary, 3 revision). Mean age was 32 years, with an average follow-up of 9.5 years. One patient (33%) in the revision group experienced a traumatic subluxation; no patients required revision surgery. Compared with primary cases, revision cases had significantly smaller glenoid track size (19.7 vs 23.9 mm, P = .02) and deeper Hill-Sachs defects (4.5 vs 3 mm, P = .03). Final Western Ontario Shoulder Instability Index scores were similar between groups (192.2 vs 193.3, P = .99). American Shoulder and Elbow Surgeons scores improved from 67.2 to 93.2 overall (P < .001), with higher scores in revisions (98.0 vs 91.7, P = .02). Single Assessment Numeric Evaluation (89 vs 86, P = .62), Simple Shoulder Test (11.5 vs 11.6, P = .69), and visual analog scale (0.8 vs 0, P = .01) were not significantly different. Nine athletes returned to sport. No complications were reported.

Conclusions: In this study, we found significant improvements in clinical and functional outcomes in both the primary and revision arthroscopic Bankart repair with remplissage groups, with only 1 patient in the revision group experiencing a traumatic instability event at the final follow-up. No patients in the primary group experienced further instability events. No patients underwent further instability surgery.

Level of evidence: Level IV, retrospective therapeutic case series.