What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study

Travis L Frantz; Joshua S Everhart; Gregory L Cvetanovich; Andrew Neviaser; Grant L Jones; Carolyn M Hettrich; Brian R Wolf; MOON Shoulder Group; Julie Bishop; Bruce Miller; Robert H Brophy; C Benjamin Ma; Charlie L Cox; Keith M Baumgarten; Brian T Feeley; Alan L Zhang; Eric C McCarty; John E Kuhn

doi:10.1177/2325967120903283

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 Feb 27;8(2):2325967120903283. doi: 10.1177/2325967120903283. eCollection 2020 Feb.

Authors

Travis L Frantz¹, Joshua S Everhart¹, Gregory L Cvetanovich¹, Andrew Neviaser¹, Grant L Jones¹, Carolyn M Hettrich¹, Brian R Wolf¹; MOON Shoulder Group; Julie Bishop¹, Bruce Miller¹, Robert H Brophy¹, C Benjamin Ma¹, Charlie L Cox¹, Keith M Baumgarten¹, Brian T Feeley¹, Alan L Zhang¹, Eric C McCarty¹, John E Kuhn¹

Affiliation

¹ Investigation performed at The Ohio State University Wexner Medical Center, Department of Orthopaedics, Columbus, Ohio, USA.

Abstract

Background: Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM).

Hypothesis: There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone.

Study design: Cohort study; Level of evidence, 2.

Methods: A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect.

Results: At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction (P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane (P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors (P = .003), increased patient age (P = .02), and preoperative side-to-side deficits in ER (P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness (P = .04), with no association with remplissage (P = .26).

Conclusion: Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.

Keywords: Bankart repair; ROM; remplissage; shoulder arthroscopic surgery; strength.