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Bankart repair with remplissage may reduce shoulder re-dislocation risk
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NEW YORK — Bankart repair with remplissage may reduce the risk of re-dislocation up to 2 years postoperatively among patients with anterior shoulder instability and a Hill Sachs lesion, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
Peter B. MacDonald, MD, and colleagues randomly assigned 108 patients with anterior shoulder instability and a Hill Sachs lesion to undergo arthroscopic Bankart repair with (n=54) or without (n=54) arthroscopic supraspinatus remplissage. Researchers recorded Western Ontario Shoulder Instability [WOSI] score, ASES scores, simple shoulder test scores, re-dislocation rates and range of motion at 3, 6, 12 and 24 months postoperatively.
“If you look at our primary outcomes, the WOSI score, there is a significant difference between pre- and postoperative scores, but no differences between the groups,” MacDonald said in his presentation here.
Similarly, the ASES and simple shoulder test scores had differences between preoperative and postoperative scores, but not between groups, he added. MacDonald noted a 28.6% recurrence rate in the no remplissage group vs. 0% in the remplissage group among patients with Hill Sachs lesions greater than 25 mm in diameter.
“We looked at range of motion. The external rotation in abduction was statistically different in the remplissage group,” MacDonald said. – by Casey Tingle
Reference:
MacDonald PB, et al. Paper 7. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: MacDonald reports he receives research support from Arthrex Inc., ConMed Linvatec and Ossur; is a board or committee member of the Canadian Orthopaedic Association; and is on the editorial or governing board of the Journal of Shoulder and Elbow Surgery and Clinical Journal of Sports Medicine.
Perspective
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John M. Tokish, MD
The paper by Peter B. MacDonald, MD, FRCS, and colleagues represents another incredible paper by his group. These randomized clinical trials are very difficult to accomplish, and the Canadian group that MacDonald has helped build continues to be the best in the world at it.
In terms of their individual question, it is timely and pertinent, it would be helpful to know whether it is necessary and/or desirable to add a remplissage in the setting of a patient with an on-track shoulder instability situation and a Hill-Sachs lesion. What they found was that the overall patient outcomes weren’t all that different, but the failure rates if you used remplissage could be reduced. This is a very important for the practicing orthopedic surgeon. I think it is compelling evidence to add an adjunct in the setting of the patient who has a Hill Sachs defect. It’s safe and it was very effective in the present study.
Mayo Clinic
Phoenix
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