Summary

Arthroscopic Bankart repair with remplissage does not result in significant strength deficits though can lead to external rotation stiffness at 6 months, particularly in older patients.

Abstract

Background

Remplissage is an adjunct surgical technique used to address a concerning Hill-Sachs lesion. The belief is that the addition of this procedure will reduce recurrent instability by preventing the engagement of the lesion on the glenoid. Previous studies have shown lower recurrence rates when this is performed. However, there is concern that the addition of this procedure during Bankart repair could significantly limit external rotation range of motion (ROM) and strength. The traditional standard of care has released athletes to return to play 6 months post-operatively despite not knowing the rates of return for strength and ROM.

Purpose

1) To evaluate rates of return of full strength and range of motion at 6 months after arthroscopic Bankart repair with remplissage. 2) To determine whether independent risk factors exist which effect these outcomes.

Methods

Ten participating sites throughout the United States enrolled patients in a prospective cohort study. Forty-six patients with primary anterior shoulder instability met inclusion criteria (mean age 27.6 SD 10.8; 89% male, 11% female) and underwent arthroscopic Bankart repair with remplissage for a Hill-Sachs defect. Recurrent instability, strength, and range of motion were assessed at 6 months. Independent predictors of postoperative stiffness were assessed with multivariate linear regression modeling including assessment of age, sex, number of anchors, anchor position, preoperative ROM, number of prior dislocations, and sports participation.

Results

Sixty-seven percent of patients experienced at least one pre-operative instability episode during sporting activities. Mean number of anchors was 4.4 (SD 1.9) for the Bankart repair 1.3 (SD 0.5) for Remplissage. There were no complications or recurrent instability episodes (subluxations or dislocations) at 6 months follow-up. The mean side-to side deficit in external rotation was 11.1 degrees (SD 11.7) with elbow at the side and 13.9 degrees (SD 13.3) with elbow at 90 degrees abduction. A 20 degree or greater ER deficit was seen in 29% with arm at side and 48% with elbow at 90 degrees abduction. ER weakness (4/5 strength) was noted in 2 patients (4%), 1 of whom had preoperative ER weakness. The only significant predictor of post-operative ER stiffness was age for both ER at side (per 5 years increase in age: 3.1 degree SE 0.9; p=0.002) and ER at 90 degrees (per 5 year increase in age: 2.1 degrees SE 0.09; p=0.03).

Conclusions

Arthroscopic Bankart repair with remplissage does not result in significant strength deficits though can lead to external rotation stiffness at 6 months, particularly in older patients.