Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up

Abstract

Background: Engaging Hill-Sachs lesions are known to be a risk factor for recurrence dislocation after arthroscopic repair in patients with anterior shoulder instability. For a large engaging Hill-Sachs lesion, arthroscopic remplissage is a solution.

Hypothesis: Arthroscopic Bankart repair combined with the Hill-Sachs remplissage technique can achieve good results without significant impairment of shoulder function.

Study design: Case Series; Level of evidence, 4.

Methods: Forty-nine consecutive patients who underwent arthroscopic Bankart repair and Hill-Sachs remplissage for anterior shoulder instability were followed up for a mean duration of 29.0 months (range, 24-35 months). There were 42 males and 7 females with a mean age of 28.4 years (range, 16.7-54.7 years). All patients had diagnosed traumatic unidirectional anterior shoulder instability with a bony lesion of glenoid and an engaging Hill-Sachs lesion. Physical examination, radiographs, and magnetic resonance imaging were performed during postoperative follow-up. The American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Rowe score were used to evaluate shoulder function.

Results: The active forward elevation increased a mean of 8.0° (range, -10° to 80°) postoperatively. However, the patients lost 1.9° (range, -40° to 30°) of external rotation to the side. Significant improvement was detected with regard to the ASES score (84.7 vs 96.0, P < .001), Constant score (93.3 vs 97.8, P = .005), and Rowe score (36.8 vs 89.8, P < .001).There were 1 redislocation, 2 subluxations, and 1 patient with a positive apprehension test; the overall failure rate was 8.2% (4 of 49). Successful healing of the infraspinatus tendon within the Hill-Sachs lesion was shown by magnetic resonance imaging.

Conclusion: Arthroscopic Bankart repair combined with Hill-Sachs remplissage can restore shoulder stability without significant impairment of shoulder function in patients with engaging Hill-Sachs lesions.