A short term analysis of external rotation deficit following a combined arthroscopic bankart with remplissage and rotator interval closure for anteroinferior instability with subcritical bone loss
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20234051Keywords:
Shoulder arthroscopy, Recurrent shoulder dislocation, External rotation deficit, Anterior shoulder instability, Remplissage, Rotator interval closure, Bankarts repairAbstract
Background: Our study aims at assessing the clinical outcomes of our patients who have undergone arthroscopic bankart and remplissage along with rotator interval closure in the treatment of anteroinferior instability with subcritical bone loss, with focus on external rotation deficit.
Methods: This is a single-center retrospective study including 48 consecutive patients who underwent surgery Arthroscopic Bankarts with remplissage procedure for anterior shoulder instability with Hill-Sachs lesion. In our study, the minimum follow-up was 6 months and the average follow-up of was 21months. At the last follow-up, active range of motion, western ontario shoulder instability index (WOSI) and University of California at Los Angeles (UCLA) scores were assessed.
Results: 48 patients who underwent surgery in the time period of 2019-2023 who completed minimum 6months follow up were included in the study. The average age of the patients was 31.7 years (range, 16-52 years), with 93.8% male patients and 6.2% female patients. The range of motion at follow-up was comparable with the normal side, with loss of terminal external rotation in 2 patients (4%). Average University of California at Los Angeles score was 30.7 and Western Ontario shoulder instability index was 3.8%. One patient had only one episode of subluxation and there was one case of infection.
Conclusions: The results of our study validate the combination of Remplissage and rotator interval closure with Bankart repair in the treatment of anterior instability with glenoid bone loss <15% irrespective of tracking of Hill Sachs lesion for excellent functional outcomes, least rate of recurrence and without significant loss of external rotation.
References
Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677-94.
Camus D, Domos P, Berard E, Toulemonde J, Mansat P, Bonnevialle N. Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: a meta-analysis. Orthop Traumatol Surg Res. 2018;104:803-9.
Mologne T, Zhao K, Hongo M, Romeo A, An KN, Provencher M. The Addition of Rotator Interval Closure After Arthroscopic Repair of Either Anterior or Posterior Shoulder Instability: Effect on Glenohumeral Translation and Range of Motion. Am J Sports Med. 2008;36:1123-31.
Yamamoto N, Itoi E, Tuoheti Y, Seki N, Abe H, Minagawa H, et al. Effect of rotator interval closure on glenohumeral stability and motion: a cadaveric study. J Shoulder Elbow Surg. 2006;15(6):750-8.
Garcia GH, Park MJ, Zhang C, Kelly JD, Huffman GR. Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage. HSS J. 2015;11(2):98-103.
Shin SJ, Kim RG, Jeon YS, Kwon TH. Critical Value of Anterior Glenoid Bone Loss That Leads to Recurrent Glenohumeral Instability after Arthroscopic Bankart Repair. Am J Sports Med. 2017;45(9):1975-81.
Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, et al. Redefining “critical” bone loss in shoulder instability. Am J Sports Med. 2015;43(7):1719-25.
Dickens JF, Owens BD, Cameron KL, DeBerardino TM, Masini BD, Peck KY, et al. The effect of subcritical bone loss and exposure on recurrent instability after arthroscopic bankart repair in intercollegiate American football. Am J Sports Med. 2017;45(8):1769-75.
Chechik O, Maman E, Dolkart O, Khashan M, Shabtai L, Mozes G. Arthroscopic rotator interval closure in shoulder instability repair: A retrospective study. J Shoulder Elbow Surg. 2010;19(7):1056-62.
Salomonsson B, Ahlström S, Dalén N, Lillkrona U. The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation. Acta Orthop. 2009;80(2):233-8.
Ellman H, Hanker G. Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction, J Bone Joint Surg Am. 1986:68:1136-44.
Levine WN, Blaine TA, Ahmad CS, editors. Arthroscopic Rotator Interval Closure. CRC Press. 2007;147-52.
Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track. J Shoulder Elbow Surg. 2007;16:649-56.
Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30:90-8.
Nobuhara K, Ikeda H. Rotator Interval Lesion. Clin Orthop Relat Res. 1987;223:44-50.
Wolf EM, Pollack ME. Hill-Sachs ‘remplissage’: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2004;20:14-5.
Nourissat G, Kilinc AS, Werther JR and Doursounian L. A prospective, comparative, radiological, and clinical study of the influence of the ‘remplissage’ procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair. Am J Sports Med. 2011;39:2147-52.
Zhu YM, Lu Y, Zhang J, Shen JW, Jiang CY. 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. Am J Sports Med. 2011;39:1640-7.
Deutsch AA, Kroll DG. Decreased range of motion following arthroscopic remplissage. Orthopedics. 2008;31:492-5.
Argintar E, Heckmann N, Wang L, Tibone JE, Lee TQ. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc. 2016;24:585-92.
Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg. 2014;23:814-20.
Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg Am. 2012;94:618-26.
Buza JA 3rd, Iyengar JJ, Anakwenze OA, Ahmad CS, Levine WN. Arthroscopic Hill-Sachs remplissage: a systematic review. J Bone Joint Surg Am. 2014;96:549-55.
Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg. 2014;23(6):814-20.
Kany J, Pankappilly B, Guinand R, Kumar HA, Amaravati RS, Valenti P. ‘Bipolar fixation’: a novel concept in the treatment of recurrent anterior shoulder instability – a prospective study of 26 cases with minimum 2-year follow-up. Tech Should Surg. 2013;14:10-6.
Franceschi F, Papalia R, Rizzello G, Franceschetti E, Del Buono A, Panascì M, et al. Remplissage repair – new frontiers in the prevention of recurrent shoulder instability: a 2-year follow-up comparative study. Am J Sports Med. 2012;40:2462-9.
Garcia GH, Wu HH, Liu JN, Huffman GR and Kelly JD IV. Outcomes of the remplissage procedure and its effects on return to sports: average 5-year follow-up. Am J Sports Med. 2016;44:1124-30.
Cho NS, Yoo JH, Juh HS, Rhee YG. Anterior shoulder instability with engaging Hill-Sachs defects: a comparison of arthroscopic Bankart repair with and without posterior capsulodesis. Knee Surg Sports Traumatol Arthrosc. 2016;24:3801-8.
Brejuin A, Girard M, Barret H, Martinel V, Mansat P, Bonnevialle N. Long-term results of arthroscopic Bankart repair with Hill-Sachs remplissage. JSES Int. 2022;6(5):723-9.
Maman E, Dolkart O, Kazum E, Rosen N, Mozes G, Drexler M, et al. Rotator interval closure has no additional effect on shoulder stability compared to Bankart repair alone. Arch Orthop Trauma Surg. 2017;137(5):673-7.
Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, et al. Long-term outcomes after Bankart shoulder stabilization. Arthroscopy. 2013;29:920-33.
Ko SH, Cha JR, Lee CC, Hwang IY, Choe CG, Kim MS. The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone. Clin Orthop Surg. 2016;8(4):428-36.
Lavoué V, Gendre P, Saliken D, Brassac A, Boileau P. The Role of Arthroscopic Soft Tissue Reconstruction for Failed Bristow-Latarjet Procedure. Arthroscopy. 2019;35(9):2581-8.
Elkinson I, Giles JW, Boons HW, Faber KJ, Ferreira LM, Johnson JA, et al. The shoulder remplissage procedure for Hill-Sachs defects: does technique matter? J Shoulder Elbow Surg. 2013;22:835-41.
MacDonald P, McRae S, Old J, Marsh J, Dubberley J, Stranges G, et al. Arthroscopic Bankart with vs without remplissage. J Shoulder Elbow Surg. 2021;30:1288-98.
