Off-track Hill–Sachs lesions do not increase postoperative recurrent instability after arthroscopic Bankart repair with selective Remplissage procedure

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 12; pp. 3864 - 3870
• Main Authors: Park, In, Kang, Jun-Seok, Jo, Yoon-Geol, Kim, Sang-Woo, Shin, Sang-Jin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2019; Springer Nature B.V
• Subjects: Adult; Arthroscopy; Bankart Lesions - surgery; Clinical outcomes; Defects; Female; Follow-Up Studies; Humans; Humerus; Joint Instability - surgery; Lesions; Male; Medicine; Medicine & Public Health; Orthopedics; Patients; Postoperative Complications; Postoperative period; Recurrence; Repair; Retrospective Studies; Shoulder; Shoulder Dislocation - surgery; Stability; Surgery; Suture Anchors; Young Adult; Bipolar; Bone defect; Arthroscopy; Glenoid track; Recurrent instability; Shoulder
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-019-05441-2

Purpose This study aimed to compare clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure, between patients with off-track and on-track Hill–Sachs lesions. Methods Patients who underwent arthroscopic Bankart repair with selective Remplissage procedure for recurrent anterior shoulder instability and were followed up for at least 2 years were included. Patients with a glenoid defect greater than 25% were excluded. According to the glenoid track concept, patients were divided into group I (off-track lesions) and group II (on-track lesions). After Bankart repair, an additional Remplissage procedure was performed selectively in patients who sustained engagement of the humeral head. The clinical outcomes and recurrence rates were evaluated. Results A total of 193 patients (23 in group I and 170 in group II) were enrolled. No significant differences were found in clinical outcomes (n.s.) or recurrence rates (n.s.) between the two groups, despite larger glenoid defects in group I (group I:17.1 ± 6.1%, and group II:13.0 ± 6.4%, P  = 0.003). In all patients, the incidence of off-track lesions was not significantly different according to the occurrence of postoperative recurrence (n.s.), whereas the glenoid defect size showed a significant difference (with recurrence: 17.9 ± 3.9%, and without recurrence: 13.2 ± 6.5%, P  = 0.002). Conclusions The presence of an off-track lesion did not alter the clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure. The glenoid defect size rather than the presence of an off-track lesion can more reliably predict postoperative recurrence. Arthroscopic Bankart repair with selective Remplissage procedure is considered one surgical option for the treatment of off-track lesions. Level of evidence III.