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Abstract

Background:

Anterior shoulder instability remains a frequent occurrence in the young, active patient. Arthroscopic remplissage in addition to anteroinferior labral (Bankart) repair is a common treatment to address subcritical bone loss and decrease recurrent dislocation. Despite increasing use, concerns remain about the long-term outcomes of remplissage given its nonanatomic nature and relative novelty.

Purpose:

To systematically review published literature to assess functional outcomes, range of motion, recurrence rates, and subsequent revision rates after arthroscopic Bankart repair with remplissage for treatment of anterior shoulder instability with minimum 5-year follow-up.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the Scopus, PubMed, and Cochrane Library databases. Clinical studies reporting functional outcomes and recurrence data at a minimum of 5 years after arthroscopic Bankart repair and remplissage for shoulder instability were included for analysis.

Results:

Three studies including 144 shoulders met the inclusion criteria. The mean clinical follow-up was 104 months (9 years), with all patients having a minimum 60 months (5 years) of follow-up. Of the included patients, 77% were male and the mean age was 29 years (range, 15-72 years), with 51% participating in contact sports. All patients had glenoid bone loss <25%. The mean Rowe score increased from 49 to 97 (P < .001). No difference was found in preoperative versus postoperative forward elevation (171° vs 176°; P = .09) or external rotation at 90° of abduction (90° vs 86°; P = .09). The overall rate of recurrent instability events was 10%, with 8% of patients having a repeat dislocation, 4% undergoing repeat operation, and 76% returning to sport.

Conclusion:

In patients who had recurrent instability with an engaging Hill-Sachs lesion and subcritical glenoid bone loss, arthroscopic Bankart repair with remplissage showed excellent functional outcomes without restricting range of motion in published literature with minimum 5-year follow-up. The recurrent instability and dislocation rates remain lower than the reported rates after isolated Bankart repair. Further reports are needed to determine the clinical outcomes at long-term follow-up.

Keywords

arthroscopy Bankart repair joint instability remplissage shoulder

Anterior shoulder instability is a frequent occurrence in the young, active population.³⁷ Anterior shoulder dislocations can be successfully managed nonoperatively or operatively, although recurrent instability remains a common complication, with rates reported as high as 75%.^5,35,44 The traumatic force of the dislocation event can create anteroinferior glenoid bone loss and a Hill-Sachs lesion of the posterosuperior humeral head, both of which can predispose patients to repeat dislocations and chronic instability if not appropriately addressed.^11,15 Arthroscopic remplissage, a posterior capsulotenodesis, in combination with anteroinferior labral (Bankart) repair, is a technique described to address patients with subcritical bone loss and associated Hill-Sachs lesions.⁴⁶ Since its introduction in 2004, arthroscopic Bankart repair with remplissage has been shown to provide good short-term results and reduced recurrence while avoiding complications in association with bone block procedures.^{8,19,26,31,48}

Despite increasing use of remplissage, concerns remain about its long-term outcomes given its nonanatomic nature and the relative lack of long-term outcome studies.¹⁰ Although reports remain mixed, several short-term clinical and biomechanical studies have shown the potential for restricted motion, particularly external rotation, after remplissage.^12,16,17,33 Remplissage, as with all surgical techniques, warrants continued follow-up.

The purpose of this study was to systematically review the literature to assess functional outcomes, range of motion, recurrence rates, and subsequent revision rates after arthroscopic Bankart repair with remplissage for treatment of anterior shoulder instability with minimum 5-year follow-up.

Methods

A systematic review of the Cochrane Library, PubMed, and Scopus was performed in adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Figure 1). Two authors completed independent searches. Disagreements regarding study inclusion were determined by the study's senior author (J.S.S.). When overlapping study populations were identified, only the most recent article was included for final review and analysis. Search terms included “Bankart AND remplissage,”“arthroscopic remplissage OR remplissage,”“shoulder instability AND remplissage,” and “remplissage AND long-term.” Level of evidence was determined per the Oxford Centre for Evidence-Based Medicine Guidelines.³⁶

Figure 1.

Study selection: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowsheet.

Inclusion criteria were clinical studies reporting either clinical or radiographic outcomes after arthroscopic Bankart repair with remplissage with a minimum 5-year follow-up period, studies with level 1 through 4 evidence, studies that included ≥2 patients, and studies published in the English language. Exclusion criteria were studies that failed to report clinical or radiographic outcomes, studies that entailed open procedures, biomechanical or surgical technique papers, scientific meeting or conference abstracts, studies that included <2 patients, and studies published in non-English languages.

Patient demographic data including age, sex, age at first dislocation, number of dislocations, and level of sports participation were collected. Preoperative Instability Severity Index Score (ISIS)² was collected when available. Percentage of glenoid bone loss and size of Hill-Sachs lesion were collected when available. Method of calculations for both glenoid and humeral-sided bone loss was determined independently by the study authors. Operative technique details included patient position and number of anchors used for remplissage. Concomitant procedure data beyond Bankart repair and remplissage were collected if present. Complication types in this review included apprehension, repeat dislocation, need for additional procedure, or other complications reported by the authors. The total complication rate was calculated by summing all reported complications. Repeat instability was defined as a positive postoperative apprehension sign, subluxation, or dislocation event. Repeat dislocation was analyzed separately. Need for repeat stabilization procedure was defined as any continued instability warranting return to the operating room.

Descriptive statistics were weighted based on the sample sizes of each group. Continuous variables were analyzed with a Student t test. Frequencies and percentages were reported for categorical data. Categorical variables were analyzed with a chi-square goodness-of-fit test. Statistical analysis was performed using R 4.40 (The R Foundation).

Results

Three studies met criteria for final analysis, with a total of 144 shoulders that underwent Bankart repair with remplissage (Table 1).^3,6,7 The mean clinical follow-up was 9 years (range, 5-13 years), with all patients having a minimum of 60 months (5 years) of follow-up. The mean patient age was 29 years (range, 16-50 years). Of these patients, 111 (77%) were male and 33 (23%) were female. Patients experienced a mean of 6 dislocations (range, 1-50) before surgery. Median number of dislocations was unavailable. One study⁷ categorized 22% of patients having <4 dislocations, whereas 78% had ≥4 dislocations. A total of 81 (56%) procedures were performed on the patient's dominant arm. All indicated patients had recurrent instability, had an engaging Hill-Sachs lesion, and lacked substantial glenoid bone loss (<25%; range, 0%-25%). All 3 articles determined engagement of the Hill-Sachs lesion with dynamic arthroscopic assessment intraoperatively,^3,6,7 with one study⁶ specifying the arm position to be in abduction and external rotation during assessment. Additional inclusion criteria included an ISIS ≥3 in one study⁷ and an ISIS ≥4 in another.³ One article did not include method for measuring glenoid or humeral bone loss.³ Two studies measured glenoid bone loss with computed tomography using the Sugaya method.⁴³ One study measured Hill-Sachs size via axial cuts of magnetic resonance imaging scans but did not specify precise method, listing 34 (52%) as medium-size lesions and 31 (48%) as large.⁷ Another study measured a ratio of the depth of the Hill-Sachs lesion to the radius of the humeral head on computed tomography scan and found a mean of 18% (9%-42%).⁶ All studies confirmed the Hill-Sachs lesion to be engaging by intraoperative dynamic evaluation.^3,6,7 A total of 106 (74%) patients participated in sports, with 69 (48%) of these participating in contact sports. The mean ISIS was 3 (range, 1-6).

Table 1

Study and Subject Characteristics^a

Parameter	Value
No. of studies analyzed	3
Level of evidence
3	2 (66)
4	1 (33)
Financial conflict of interest
Yes	00 (0)
No	2 (67)
Not reported	1 (33)
Shoulders, n	144
Male	111 (77)
Female	31 (23)
Mean subject age, y (range)	29.0 (16-50)
No. of dislocations before surgery (range)	6.4 (1-50)
No. of procedures on dominant arm	81 (56)
Glenoid bone loss
0%-25%	116 (81)
>25%	00 (0)
Not reported	28 (19)
Participation in sports	106 (74)
Participation in contact sports	69 (48)
Mean Instability Severity Index Score (range)	2.7 (1-6)
Mean follow-up, y (range)	8.7 (5-12.5)

Data expressed as n (%) unless otherwise noted.

Two groups^3,6 performed the procedure with patients in a beach-chair position, whereas 1 group⁷ used the lateral position. Two groups routinely used 2 anchors for remplissage,^3,6 whereas the other group⁷ used 1 or 2 anchors on a case-by-case basis. No additional procedures were reported.

The mean Rowe score increased from 49 to 97 (P < .001). Two studies reported a final Walch-Duplay score of 87.7 (range, 70-100).^3,6 Changes in strength were too infrequently recorded to review. At final follow-up, no difference was reported in preoperative versus postoperative forward elevation (171° vs 176°; P = .09) or external rotation at 90° of abduction (90° vs 86°; P = .09) (Table 2). The mean reachable internal rotation thoracic vertebral level was unchanged from a mean of T10. Of 116 patients, 88 (76%) returned to sport by final follow-up. One study reported data on return to play at the same level (69%).⁶

Table 2

Outcomes After Bankart Repair and Remplissage

Parameter	Preoperative	Postoperative	P
Rowe score	49	97	<.001
External rotation, deg	90	86	.09
Forward elevation, deg	171	176	.53
Return to sport, %		76

The overall rate of recurrent instability events was 10% (n = 15), with 8% of cases (n = 11) having a repeat dislocation and 4% (n = 5) undergoing repeat operation (Table 3). Of the 11 dislocations, 9 occurred within the first 13 months and 7 occurred during contact sport activity or trauma. One study⁶ analyzed patients who sustained recurrent postoperative dislocation and found that they were younger (mean 20 vs 23 years; P = .04) and had deeper Hill-Sachs lesions (25% vs 18%; P = .03). Each of the 5 patients who required an additional stabilization procedure underwent a Latarjet coracoid transfer. Four (3%) other complications included 1 case of transient ulnar nerve palsy, 1 case of mechanical symptoms, 1 case of early fatigue, and 1 case of temperature hypersensitivity. When factoring instability events, repeat operations, and other complications, the overall complication rate was 17% (n = 24).

Table 3

Complications and Reoperations

Parameter	n	%
Total complications	24	17
Recurrent instability	15	10
Recurrent dislocation	11	8
Revision stabilization procedure	5	4
Transient ulnar nerve palsy	1	1
Mechanical symptoms	1	1
Early fatigue	1	1
Hypersensitivity	1	1

Due to limited literature availability and stringent inclusion criteria, only a small number of studies were available for analysis after systematic review. However, our literature search identified 6 additional studies that had a mean, but not minimum, follow-up of >5 years.^{4,13,28,30,32,40} The results of 5-year mean and minimum follow-up studies were pooled for exploratory post hoc descriptive analysis. An additional 307 patients were included in this analysis for a total of 502 patients. Mean age was 28 years (range, 15-72 years). The mean follow-up was 7 years (range, 2-15 years). Preoperative forward elevation and external rotation at 90° of abduction were 168° and 82°, respectively. Postoperative forward elevation and external rotation at 90° of abduction were 173° and 82°, respectively. The Rowe score improved from 49 to 93. The repeat instability rate was 6% (n = 32), and the dislocation rate was 5% (n = 23). Return to sport was possible for 88% (291 of 332) of patients. Twelve additional reoperations were detected in pooled analysis, with a reoperation rate of 3% (n = 17). Two patients underwent arthroscopic debridement for stiffness, 8 patients underwent a Latarjet procedure, 1 patient underwent revision Bankart repair with remplissage, and 1 patient was converted to a total shoulder arthroplasty.

Discussion

The purpose of this systematic review was to evaluate the outcomes and complications of arthroscopic Bankart repair with remplissage at a minimum 5-year follow-up. Our goal was to provide clinical insights and facilitate evidence-based discussions on the efficacy and safety of a relatively new nonanatomic procedure. The most important finding was that at midterm follow-up, Bankart repair with remplissage had a 90% successful stabilization rate without significant loss of shoulder range of motion in patients with recurrent instability, an engaging Hill-Sachs lesion, and subcritical glenoid bone loss.

Indications for remplissage remain unclear.⁸ All patients from this review had a history of recurrent instability, glenoid bone loss <25%, and an engaging Hill-Sachs lesion. Recent studies have reported low rates of recurrent dislocations and high return to sport after combined Bankart remplissage in patients with engaging Hill-Sachs lesions, nonengaging Hill-Sachs lesions, and first-time dislocations with concern for future instability.^39,40,45 Pawłuś et al³⁹ found a recurrent instability rate of 5% in a review of 7 studies reporting 2-year outcomes after combined Bankart remplissage compared with 30% in Bankart repair in patients with an engaging Hill-Sachs lesion and <25% glenoid bone loss. Despite heterogeneity in bone loss measurement methods between studies in the current analysis and Pawłuś’s report, their 5% recurrent instability rate appears comparable with the 10% recurrence seen at 5 years in the current review. Due to the relatively narrow indications in our included studies, we are unable to draw specific conclusions on the ideal indications and contraindications for combined Bankart remplissage. Although paradigms around shoulder instability continue to evolve, consistency in quantitative bone loss method and categorization of subcritical bone loss by future investigators will be critical to better understand which injury patterns benefit most from additional remplissage long-term.^42,48

The clinical outcomes of Bankart repair at mid- and long-term follow-up have previously been reported. Harris et al²¹ reported the outcomes of arthroscopic or open Bankart repair at minimum 5-year follow-up. Final Rowe score was 87, and 74% of patients returned to sport at the same level of play. Murphy et al³⁴ later reported Bankart repair outcomes at minimum 10-year follow-up, finding a final Rowe score of 87, with a 77% rate of return to play. Similarly, Hurley et al²⁵ reported a final Rowe score of 89, with 76% of patients returning to same-level play 10 years after Latarjet. The final Rowe score after Bankart remplissage in our review was 97, which appears favorable in comparison to that of isolated Bankart repair or bone block transfer. The superior outcome scores seen in this review may be attributed to reduced positional apprehension and instability rates after remplissage, as these have been shown to be a predictor of successful 5-year outcomes.²⁴ However, it is unclear whether improved Rowe scores translate to improved athletic participation, because return-to-sport levels appear consistent across all stabilization procedures.^21,25,34 Radiographic evidence of instability arthropathy after stabilization procedures is a potential long-term adverse outcome that has previously been reported in 60% and 36% of cases 10 years after Bankart repair and Latarjet, respectively.^25,34 Radiographic outcomes were not described in our included studies, although this may be an area for future investigators to report.

Despite increasing use of combined Bankart repair and remplissage, concerns about loss of motion after the procedure remain. Historically, nonanatomic stabilization procedures such as the Putti-Platt, Magnusson-Stack, and anterior capsulorrhaphy fell out of favor due to iatrogenic reduction of motion, increased joint stiffness, and subsequent development of glenohumeral osteoarthritis.^29,30 Elkinson et al¹² found that the addition of remplissage decreased shoulder rotation by 15° in adduction and increased joint stiffness compared with Bankart repair alone in cadaveric studies. In contrast, Argintar et al¹ performed a cadaveric study and did not report reduction in motion after addition of remplissage but found that the apex of the humeral head shifted posteriorly and inferiorly at 60° of abduction and maximum external rotation. Differences in biomechanical outcomes may be explained by differences in surgical technique, as Feng et al¹⁴ found that medially placed anchors and use of multiple anchors decreased humeral head displacement in a finite element motion analysis.

Some clinical studies have also found early loss of shoulder rotation motion after remplissage,^16,22 although other authors found no difference.^23,45 MacDonald et al³¹ reported the 2-year results of a level 1 clinical trial in which patients with recurrent instability and an engaging Hill-Sachs lesion were randomized to Bankart repair alone or Bankart repair with remplissage. At 1 year, patients in the remplissage group had significantly decreased external rotation in abduction (75° vs 86°; P < .003), although motion in the remplissage group was equal to that of isolated Bankart repair at 2 years. The 4-year results of this randomized trial were recently published, although range of motion at midterm follow-up was not reported.⁴⁷ At minimum 5-year follow-up, we found that mean forward elevation was 176° and mean external rotation was 86°, neither of which was significantly different from preoperative values. These values are comparable with those reported in isolated Bankart repair series with long-term follow-up.^9,27 Similarly, data from the post hoc exploratory analysis of articles^{4,13,28,30,32,40} with mean follow-up of 5 years suggest that range of motion is not diminished compared with the patient's preoperative state, although it should be noted that 2 patients in one study³² required arthroscopic debridement for stiffness. Continued publication of midterm and long-term follow-up may reveal whether changes in glenohumeral joint stiffness and kinematics lead to changes in motion over time.

Recurrent instability after anterior stabilization procedures remains a concern. We found that the overall rate of recurrent instability at 5-year minimum follow-up was 10%, with 8% having a repeat dislocation and 4% undergoing repeat operation. Woodmass et al⁴⁷ reported the 4-year outcomes of a previously published randomized controlled trial comparing isolated Bankart repair versus Bankart and remplissage. The rates of instability and dislocation after remplissage in their study are identical to the rates reported in the current systematic review. Notably, the instability and dislocation rates of isolated Bankart in the report by Woodmass et al were 30% and 22%, respectively. Patients were excluded from their trial if glenoid bone loss exceeded 15%, whereas several included patients in the current analysis had glenoid bone loss 16% to 20%. Addition of remplissage appears to result in a high success rate at midterm follow-up across a wide range of glenoid bone loss, as has previously been reported at short-term follow-up.²² Importantly, the risk of recurrent instability appears to remain comparable, if not superior, to isolated Bankart repair. The rate of instability after isolated Bankart repair in studies with >5-year follow-up ranges from 11% to 32%.^21,24,34,38 Remplissage appears to be particularly beneficial to patients with engaging or “off-track” Hill-Sachs lesions. All patients in the current review were found to have an engaging Hill-Sachs on dynamic assessment. Schwihla et al⁴¹ found that patients with these findings treated with isolated Bankart repair had a 74% recurrence rate and 48% reoperation rate. Some surgeons may prefer to perform a Latarjet in a high-risk patient. Although comparative studies beyond short-term follow-up are lacking, Bankart repair with remplissage appears to have a success rate comparable with Latarjet at mid- to long-term follow-up.^18,25 Although the time and the implants required to perform remplissage inherently add cost to the procedure, it is unclear whether the reduced rate of recurrent instability would lead to net cost savings for health systems. Future investigators may consider performing a cost analysis of Bankart repair and remplissage versus alternative treatments to better understand this relationship.

One proposed benefit of Bankart repair with remplissage over bone block procedures for instability cases in patients with subcritical bone loss is a lower rate of complications.^20,22,48 Haroun et al²⁰ performed a systematic review of studies comparing Bankart repair with remplissage versus Latarjet for patients with subcritical bone loss and an engaging Hill-Sachs lesion. Those investigators reported similar functional outcomes and recurrent stability between the 2 procedures but noted that Latarjet had a 7-fold greater complication rate. Gouveia et al¹⁹ found similar results in a systematic review that also included patients undergoing bone block transfer with either iliac crest or distal tibia allograft. Overall, the reported complication rate after bone block procedures ranges from 6% to 66%.^19,20,22,48 In our review, 4 patients (3%) had complications unrelated to recurrent instability. This is slightly more than the 1% described in the 2-year outcomes report of a randomized clinical trial.⁴⁴ This may reflect differences in reporting protocols or increased discovery of complications with prolonged follow-up. Bankart repair with remplissage appears to be an effective procedure associated with a lower complication rate than bone-block procedures at 5-year follow-up.

The current systematic review had some limitations. Due to stringent inclusion criteria and few published studies, only 3 retrospective studies met criteria for final analysis, all of which were retrospective level 3 and 4 evidence. Therefore, our results are inherently limited by the biases to which retrospective studies are subject. Although the small number of studies found during systematic review of the literature precludes a more robust analysis, we believe that it also highlights an important shortcoming in our understanding of midterm outcomes of an increasingly performed and researched procedure. The lack of a comparison group to alternative stabilization procedures such as isolated Bankart repair is an inherent limitation of these data. Continued communication of results from a previously reported level 1 randomized trial comparing Bankart repair with versus without remplissage will certainly provide valuable clinical insights.^31,47 We would encourage the authors to assess range of motion presented in the 2-year outcomes report but absent in the recent 4-year outcomes study. Furthermore, 6 additional studies^{4,13,28,30,32,40} were identified with a mean, but not minimum, 5-year follow-up. The orthopaedic community would benefit from continued follow-up of these cohorts, as doing so could triple the current body of literature regarding minimum 5-year follow-up. An additional limitation of this review is the lack of comparison between Bankart remplissage and alternative stabilization procedures. As the volume of literature increases, future investigators may be able to perform comparative analyses of outcomes after isolated Bankart repair with Bankart remplissage. Lack of consistent reporting of factors such as baseline activity level, quantitative bipolar bone loss, presence of associated injuries, anchor position, and repair technique potentially confounded outcomes. We were unable to determine the median number of dislocations before surgical intervention or perform outcome analysis stratified by number of preoperative dislocations. The small sample sizes of the included studies likely introduced variability due to differences in patient factors, rehabilitation protocols, and selected outcomes—all of which potentially weaken the external validity of our findings. Increased use of validated outcome scores would be beneficial in future works. Finally, the studies included in our systematic review were authored from academic centers by early adopters of remplissage, and their results may not be reproducible in all practice models. Despite these limitations, this systematic review provides relevant insights on an increasingly performed procedure for a common condition and highlights the need for more literature reporting long-term outcomes.

Conclusion

In patients with an engaging Hill-Sachs lesion and subcritical glenoid bone loss who experienced recurrent instability, arthroscopic Bankart repair with remplissage showed excellent functional outcomes without restricting range of motion in published literature with minimum 5-year follow-up. The recurrent instability and dislocation rate remains lower than the reported rates after isolated Bankart repair. Further reports are needed to determine the clinical outcomes at long-term follow-up.

Footnotes

Submitted October 31, 2024; accepted December 20, 2024.

One or more of the authors has declared the following potential conflict of interest or source of funding: P.J.T. has received hospitality payments from Stryker. V.C.B.R. has received hospitality payments from Medical Device Business Services. R.W.L. has support for education from Medinc of Texas, Arthrex, Smith & Nephew, and Alon Medical Technology and hospitality payments from Stryker. J.S.S. has received food and beverage from Stryker, Integra LifeSciences, Skeletal Dynamics, Bioventus LLC, Amgen, Smith & Nephew, ConvaTech, Zimmer Biomet Holdings, Arthrex, Encore Medical LP, CoreLink LLC, Biedermann Medtech, Nuvasive, Halyard Health, and Biocomposites; support for education from Medinc of Texas and Arthrex; and travel and lodging from Medinc of Texas and Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

An online CME course associated with this article is available for 1 AMA PRA Category 1 Credit™ at https://education.sportsmed.org/Public/Catalog/Home.aspx?CourseSearch=1&Criteria=9&Option=25. In accordance with the standards of the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The American Orthopaedic Society for Sports Medicine that authors, editors, and planners disclose to the learners all financial relationships during the past 12 months with any commercial interest (A ‘commercial interest’ is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients). Any and all disclosures are provided in the online journal CME area which is provided to all participants before they actually take the CME activity. In accordance with AOSSM policy, authors, editors, and planners’ participation in this educational activity will be predicated upon timely submission and review of AOSSM disclosure. Noncompliance will result in an author/editor or planner to be stricken from participating in this CME activity.

References

Argintar

Heckmann

Wang

Tibone

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(2):585-592.

Balg

Boileau

The instability severity index score: a simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470-1477.

Bastard

Herisson

Gaillard

Nourissat

Impact of remplissage on global shoulder outcome: a long-term comparative study. Arthroscopy. 2019;35(5):1362-1367.

Bitar

Fabiani

Ferrari

, et al. Clinical and functional outcomes of the remplissage technique to repair anterior shoulder dislocation: average 7 years of follow-up. Musculoskelet Surg. 2021;105(1):61-67.

Bottoni

Wilckens

DeBerardino

, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30(4):576-580.

Brejuin

Girard

Barret

Martinel

Mansat

Bonnevialle

Long-term results of arthroscopic Bankart repair with Hill-Sachs remplissage. JSES Int. 2022;6(5):723-729.

Brilakis

Avramidis

Malahias

, et al. Long-term outcome of arthroscopic remplissage in addition to the classic Bankart repair for the management of recurrent anterior shoulder instability with engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):305-313.

Buza

III Iyengar

Anakwenze

Ahmad

Levine

WN.

Arthroscopic Hill-Sachs remplissage: a systematic review. J Bone Joint Surg Am. 2014;96(7):549-555.

Chapus

Rochcongar

Pineau

Salle

Chou

Hulet

Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients. Orthop Traumatol Surg Res. 2015;101(8):889-893.

10.

Denard

PJ.

Editorial commentary: remplissage for all: hammer and a nail or the necessary adjunct to arthroscopic Bankart repair?

Arthroscopy. 2019;35(2):629-630.

11.

Di Giacomo

Itoi

Burkhart

. 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(1):90-98.

12.

Elkinson

Giles

Faber

, et al. The effect of the remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am. 2012;94(11):1003-1012.

13.

Feng

Chen

Patient outcomes and fear of returning to sports after arthroscopic Bankart repair with remplissage. Orthop J Sports Med. 2021;9(4):23259671211001775.

14.

Feng

Chen

Bankart repair with remplissage restores better shoulder stability than Bankart repair alone, and medial or two remplissage anchors increase stability but decrease range of motion: a finite element analysis. Arthroscopy. 2022;38(11):2972-2983.e2973.

15.

Fox

Sanchez

Zajac

Provencher

MT.

Understanding the Hill-Sachs lesion in its role in patients with recurrent anterior shoulder instability. Curr Rev Musculoskelet Med. 2017;10(4):469-479.

16.

Frantz

Everhart

Cvetanovich

, et al. What are the effects of remplissage on 6-month strength and range of motion after arthroscopic Bankart repair? A multicenter cohort study. Orthop J Sports Med. 2020;8(2):2325967120903283.

17.

Garcia

Liu

Huffman

Kelly

JD.

Outcomes of the remplissage procedure and its effects on return to sports: average 5-year follow-up. Am J Sports Med. 2016;44(5):1124-1130.

18.

Gilat

Lavoie-Gagne

Haunschild

, et al. Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: a systematic review. Shoulder Elbow. 2020;12(5):315-329.

19.

Gouveia

Abidi

Shamshoon

, et al. Arthroscopic Bankart repair with remplissage in comparison to bone block augmentation for anterior shoulder instability with bipolar bone loss: a systematic review. Arthroscopy. 2021;37(2):706-717.

20.

Haroun

Sobhy

Abdelrahman

AA.

Arthroscopic Bankart repair with remplissage versus Latarjet procedure for management of engaging Hill-Sachs lesions with subcritical glenoid bone loss in traumatic anterior shoulder instability: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(10):2163-2174.

21.

Harris

Gupta

Mall

, et al. Long-term outcomes after Bankart shoulder stabilization. Arthroscopy. 2013;29(5):920-933.

22.

Horinek

Menendez

Narbona

Lädermann

Barth

Denard

PJ.

Remplissage yields similar 2-year outcomes, fewer complications, and low recurrence compared to Latarjet across a wide range of preoperative glenoid bone loss. Arthroscopy. 2022;38(10):2798-2805.

23.

Hughes

Bastrom

Pennock

Edmonds

EW.

Arthroscopic Bankart repairs with and without remplissage in recurrent adolescent anterior shoulder instability with Hill-Sachs deformity. Orthop J Sports Med. 2018;6(12):2325967118813981.

24.

Hurley

Davey

Mojica

, et al. Evaluation of factors associated with successful 5-year outcomes following arthroscopic Bankart repair in athletes. Knee Surg Sports Traumatol Arthrosc. 2022;30(6):2092-2098.

25.

Hurley

Jamal

Ali

Montgomery

Pauzenberger

Mullett

Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2019;28(2):e33-e39.

26.

Hurley

Toale

Davey

, et al. Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(12):2487-2494.

27.

Kartus

Matis

Forstner

Resch

Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks: a clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am. 2007;89(7):1442-1448.

28.

Cha

Lee

Hwang

Choe

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):428-436.

29.

Levy

Cole

Bach

Jr.

History of surgical intervention of anterior shoulder instability. J Shoulder Elbow Surg. 2016;25(6):e139-e150.

30.

Lusardi

Wirth

Wurtz

Rockwood

Jr.

Loss of external rotation following anterior capsulorrhaphy of the shoulder. J Bone Joint Surg Am. 1993;75(8):1185-1192.

31.

MacDonald

McRae

Old

, et al. Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg. 2021;30(6):1288-1298.

32.

Martinez-Catalan

Kazum

Zampeli

Cartaya

Cerlier

Valenti

Long-term outcomes of arthroscopic Bankart repair and Hill-Sachs remplissage for bipolar bone defects. Eur J Orthop Surg Traumatol. 2023;33(4):947-953.

33.

Merolla

Paladini

Di Napoli

Campi

Porcellini

Outcomes of arthroscopic Hill-Sachs remplissage and anterior Bankart repair: a retrospective controlled study including ultrasound evaluation of posterior capsulotenodesis and infraspinatus strength assessment. Am J Sports Med. 2015;43(2):407-414.

34.

Murphy

Hurley

Pauzenberger

Mullett

Long-term outcomes of the arthroscopic Bankart repair: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2019;28(11):2084-2089.

35.

Novakofski

Melugin

Leland

Bernard

Krych

Camp

CL.

Nonoperative management of anterior shoulder instability can result in high rates of recurrent instability and pain at long-term follow-up. J Shoulder Elbow Surg. 2022;31(2):352-358.

36.

Obremskey

Pappas

Attallah-Wasif

Tornetta

III Bhandari

Level of evidence in orthopaedic journals. J Bone Joint Surg Am. 2005;87(12):2632-2638.

37.

Owens

Duffey

Nelson

DeBerardino

Taylor

Mountcastle

SB.

The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-1173.

38.

Panzram

Kentar

Maier

Bruckner

Hetto

Zeifang

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study. BMC Musculoskelet Disord. 2020;21(1):191.

39.

Pawłuś

Kanak

Frankiewicz

, et al. Remplissage may decrease the redislocation rate after arthroscopic Bankart repair in patients with an engaging Hill-Sachs defect: a systematic review and meta-analysis of studies with minimal 2-year follow-up. Am J Sports Med. Published online May 14, 2024. doi:10.1177/03635465241249492

40.

Scanaliato

Dunn

Fitzpatrick

Czajkowski

Parnes

Double-pulley remplissage in active-duty military population with off-track anterior shoulder instability results in improved outcomes and low recurrence at minimum 4-year follow-up. Arthroscopy. 2022;38(3):743-749.

41.

Schwihla

Wieser

Grubhofer

Zimmermann

SM.

Long-term recurrence rate in anterior shoulder instability after Bankart repair based on the on- and off-track concept. J Shoulder Elbow Surg. 2023;32(2):269-275.

42.

Shaha

Cook

Song

, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719-1725.

43.

Sugaya

Moriishi

Kanisawa

Tsuchiya

Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. J Bone Joint Surg Am. 2005;87(8):1752-1760.

44.

van Spanning

Verweij

LPE

Priester-Vink

van Deurzen

DFP

van den Bekerom

MPJ

. Operative versus nonoperative treatment following first-time anterior shoulder dislocation: a systematic review and meta-analysis. JBJS Rev. 2021;9(9).

45.

Villarreal-Espinosa

Saad Berreta

Cotter

, et al. Lower range of recurrent instability rates following Bankart repair and remplissage compared to isolated Bankart repair in patients with “nonengaging/on-track” Hill-Sachs lesions and <20% glenoid bone loss. Arthroscopy. Published online May 11, 2024. doi:10.1016/j.arthro.2024.04.036

46.

Wolf

Pollack

ME.

Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion (SS-32). Arthroscopy. 2004;20(suppl 1):e14-e15.

47.

Woodmass

McRae

Lapner

, et al. Arthroscopic Bankart repair with remplissage in anterior shoulder instability results in fewer redislocations than Bankart repair alone at medium-term follow-up of a randomized controlled trial. Am J Sports Med. 2024;52(8):2055-2062.

48.

Yang

Mehran

Mazzocca

Pearl

Chen

Arciero

RA.

Remplissage versus modified Latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Am J Sports Med. 2018;46(8):1885-1891.

Arthroscopic Bankart Repair With Remplissage Results in Low Recurrent Instability Rates Without Reducing Shoulder Range of Motion at Midterm Follow-up: A Systematic Review of Studies With Minimum 5-Year Outcomes

Abstract

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Methods

Results

Discussion

Conclusion

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References