Summary

Hill-Sachs lesion remplissage and Bankart repair is a safe procedure for recurrent anterior dislocation in athletes with a high rate of return to play at the preinjury level and low complication rate.

Abstract

Anterior shoulder instability is a disabling condition in athletes. The management of engaging Hill-Sachs lesions is still debated and remplissage procedure is emerging as one of the most popular arthroscopic techniques. The aim of this study was to evaluate mid-term outcomes and return to sport in athletes after Bankart repair and Hill-Sachs remplissage.All overhead athlete patients surgically treated for anterior shoulder instability between 2012 and 2015 with Bankart repair with engaging Hill-Sachs remplissage were enrolled in a prospective non-randomised study. Exclusion criteria were shoulders with consistent glenoid bone defects (glenoid deficiency > 25%), GH arthritis and follow-up less than 2 years. All Hill-Sachs lesions were "off track" by an arthroscopic examination and preoperative imaging. All patients were undergone a similar rehab program with delayed return to sports at a minimum of 6 months. At the final follow-up active range of motion and clinical scores (Rowe, Costant scores and Western Ontario Shoulder Instability Index) were assessed. External rotation (ER) and internal rotation (IR) were measured with arm at the side (ER1 and IR1) and abducted at 90° (ER2 and IR2).Of 36 patients treated for traumatic recurrent anterior shoulder instability, 27 (75%) patients (60% male) were available for the follow-up (24 to 61 months, average 43 months). The average patient age at surgery was 26 years (range, 17 - 39 years). The Hill-Sachs lesion defect was measured and showed an average bone loss of 18.7% (9.3% to 29.4%) in relation to the diameter of the humeral head. Rowe, Costant scores and Western Ontario Shoulder Instability Index improved respectively at 95, 87.4 and 123 points. The mean deficit in external rotation was 8° in ER1 and 2° in ER2. Two patients had a recurrence of instability with persistent anterior apprehension. 25 (92%) patients returned to sport at the same level of play (preinjury level). All patients had no reoperations or complications.
Hill-Sachs lesion remplissage and Bankart repair is a safe procedure for recurrent anterior dislocation in athletes with a high rate of return to play at the preinjury level and low complication rate