Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure

Orthop Traumatol Surg Res. 2018 Feb;104(1):17-22. doi: 10.1016/j.otsr.2017.11.009. Epub 2017 Dec 14.

Abstract

Background: The objective of this study was to compare short-term shoulder stability after arthroscopic Bankart repair with remplissage versus the open Latarjet procedure in patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion.

Hypothesis: The dislocation recurrence rate is higher after Bankart repair with remplissage than after open Latarjet.

Patients and methods: An observational non-randomised retrospective cohort study was conducted at two surgical centres in patients treated for chronic anterior shoulder instability with a significant Hill-Sachs defect between January 2009 and July 2014. The study compared 43 patients managed by arthroscopic Bankart repair and remplissage and 43 patients managed with open Latarjet. The two groups were matched on age at surgery and on follow-up duration. All patients were evaluated by independent observers based on a questionnaire including recurrences, range of motion, and functional outcomes (Shoulder Subjective Value [SSV], Walch-Duplay score, and Rowe score).

Results: Mean follow-up was 47.3 months (range, 24-67 months). The recurrence rate at last follow-up was not significantly different between the two groups (9.3% versus 11.2%; P=0.67). The Bankart group had significantly greater loss of external rotation and a significantly higher proportion of patients with residual pain (21% versus 9%, P=0.023). The SSV, Walch-Duplay score, and Rowe score values were similar between groups.

Discussion: In patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion, arthroscopic Bankart repair with remplissage and open Latarjet were reliable and safe procedures associated with low and similar recurrence rates. However, loss of external rotation and residual pain were significantly more common with the combined Bankart-remplissage procedure.

Level of evidence: III; comparative retrospective study.

Keywords: Anterior shoulder instability; Arthroscopy; Hill–Sachs lesion; Latarjet.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Arthroplasty / methods*
  • Arthroscopy
  • Bankart Lesions / complications
  • Bankart Lesions / physiopathology
  • Bankart Lesions / surgery*
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Instability / complications
  • Joint Instability / physiopathology
  • Joint Instability / surgery*
  • Male
  • Range of Motion, Articular
  • Recurrence
  • Retrospective Studies
  • Rotation
  • Shoulder Dislocation / physiopathology
  • Shoulder Dislocation / surgery*
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery*
  • Shoulder Pain / etiology
  • Young Adult