Original Article With Video Illustration
Primary Versus Revision Arthroscopic Reconstruction With Remplissage for Shoulder Instability With Moderate Bone Loss

https://doi.org/10.1016/j.arthro.2013.12.015Get rights and content

Purpose

This study aims to evaluate our outcomes of arthroscopic remplissage in this setting.

Methods

A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score.

Results

Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage (“revision surgery”). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001).

Conclusions

In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting.

Level of Evidence

Level IV, therapeutic case series.

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.

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