Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original Article With Video IllustrationPrimary Versus Revision Arthroscopic Reconstruction With Remplissage for Shoulder Instability With Moderate Bone Loss
Section snippets
Methods
Institutional review board approval was obtained for a retrospective review of consecutive patients who underwent arthroscopic Bankart reconstruction for recurrent anterior shoulder instability with remplissage of a Hill-Sachs lesion at our institution, in whom a minimum of 24 months of follow-up could be obtained.
As described by Burkhart and DeBeer,1 the primary indication for remplissage was an engaging Hill-Sachs lesion identified at the time of surgery by either direct arthroscopic
Demographic Characteristics
A total of 36 shoulders in 35 patients were identified. Follow-up was available on 31 shoulders (30 patients, 86% follow-up); the remaining 5 patients were lost to follow-up. The mean age at the time of remplissage was 24.6 years (range, 15.8 to 44.7 years). The mean follow-up period was 41 months (range, 24 to 68 months); 11 patients (35%) had follow-up of 4 years or more. There were 29 male patients (30 shoulders) and 1 female. Remplissage was performed in the context of revision surgery in
Discussion
Rowe et al.3 found that a Hill-Sachs lesion was present in 76% of patients in whom surgical treatment of recurrent instability failed, although only 14% of those patients were determined to have a “large” Hill-Sachs defect (4 cm long, 1 cm wide). This finding suggests that even relatively small Hill-Sachs lesions may be functionally significant if a corresponding anterior glenoid deficiency is present. This pathologic bony environment is responsible for the loss of articular congruity
Conclusions
This study reports a series of 30 patients (31 shoulders) undergoing arthroscopic Bankart reconstruction with remplissage with a mean follow-up period of 41 months, including 11 patients with a follow-up period of 4 years or more. It is the first series to analyze this technique in the setting of revision surgery with moderate glenohumeral bone loss. Our series showed no failures among patients undergoing primary arthroscopic Bankart reconstruction with remplissage. For revision surgery, there
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The authors report the following potential conflict of interest or source of funding: L.D.F. receives support from Smith & Nephew and Mitek. M.J.O. receives support from DePuy Mitek and Smith & Nephew. E.R.H. is a paid consultant for Arthrex. F.H.S. receives support from DePuy Mitek and Smith & Nephew.