RESEARCH ARTICLE


Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability



Ryosuke Miyamoto1, *, Atsushi Yamamoto1, Hitoshi Shitara1, Tsuyoshi Ichinose1, Daisuke Shimoyama2, Tsuyoshi Sasaki1, Noritaka Hamano1, Tsutomu Kobayashi3, Toshihisa Osawa4, Kenji Takagishi2
1 Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan
2 St. Pierre Hospital - Orthopaedic Surgery, Takasaki, Gunma, Japan
3 Takasaki University of Health and Welfare - Physical Therapy, Takasaki, Gunma, Japan
4 National Hospital Organization Takasaki General Medical Center - Orthopaedic Surgery, Takasaki, Gunma, Japan


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© 2017 Miyamoto et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Gunma University Graduate School of Medicine - Orthopaedic Surgery, Maebashi, Gunma, Japan, Tel: +81-27-220-7111; Email: rmiyamoto47@gmail.com


Abstract

Purpose:

We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation.

Methods:

Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively.

Results:

Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up.

Conclusion:

Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.

Keywords: Shoulder instability, Bankart lesion, Hill-Sachs lesion, Bankart repair, Remplissage, Arthroscopic repair.