Remplissage Versus Modified Latarjet for Off-Track Hill-Sachs Lesions With Subcritical Glenoid Bone Loss

Abstract

Background: Off-track Hill-Sachs lesions have been associated with high rates of recurrent shoulder instability. Both arthroscopic Bankart with remplissage and modified Latarjet have been described to treat off-track Hill-Sachs lesions. However, few comparative studies exist between the 2 techniques in heterogeneous populations.

Hypothesis: Remplissage would have similar recurrence rates and clinical outcomes to modified Latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss.

Study design: Cohort study; Level of evidence, 3.

Methods: Between 2005 and 2015, 189 patients with recurrent anterior shoulder instability, off-track Hill-Sachs lesion, and less than 25% glenoid bone loss were identified. Arthroscopic Bankart with remplissage (group A) was performed in 98 patients, and modified Latarjet (group B) was performed in 91 patients. Surgeries were performed by multiple fellowship-trained surgeons at 2 centers. The mean follow-up time was 3.2 years. Patients were assessed for their risk of recurrence using the Instability Severity Index Score and had preoperative 3-dimensional imaging to assess humeral and glenoid bone loss, along with measurement of the glenoid track. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), visual analog scale (VAS) for pain, range of motion, recurrence rate, subsequent procedures, and complications were analyzed.

Results: When comparing the remplissage and Latarjet groups, the remplissage group had a higher VAS pain score (2.2 vs 1.55, P = .041) and less internal rotation motion in abduction (40.9° vs 53.2°, P = .006). The complication rate was higher in the Latarjet group (12.1% vs 1%, P = .002). There was no difference between the 2 groups in patient-reported outcomes, such as WOSI and SANE. In addition, there was no difference between the 2 groups in revision rate and episodes of recurrent instability. In subgroup univariate analysis of revision patients, the remplissage group had higher VAS pain score (3.6 vs 2.2, P = .001), higher recurrence rate (34.8% vs 10.3%, P = .042), higher revision rate (43.5% vs 15.4%, P = .019), and lower complication rate (4.35% vs 28.2%, P = .024). For patients with >15% glenoid bone loss, Latarjet had lower recurrence rate (6.06% vs 28.6%, P = .034) and lower revision rate (3.03% vs 21.4%, P = .041). In collision and contact athletes, Latarjet had better WOSI scores (138 vs 231, P = .019) and lower recurrence rate (30% vs 0%, P = .005). In multivariate analysis, the odds of recurrence in the remplissage group were higher than in the Latarjet group in patients with previous instability surgery (3.56, P = .006), collision and contact athletes (2.37, P = .02), those with 10% to 15% glenoid bone loss (1.28, P = .04), and those with >15% glenoid bone loss (6.48, P = .001).

Conclusion: For off-track Hill-Sachs lesions with subcritical glenoid bone loss, both the remplissage and modified Latarjet can achieve satisfactory results with the initial surgical intervention in the general population, but a higher complication rate was observed in the Latarjet group. However, Latarjet appears to be a better choice in patients with revision instability surgery, collision and contact athletes, and those with >10% glenoid bone loss.

Keywords: bone loss; contact athletes; glenoid track; revision; shoulder instability.