Bankart repair with remplissage may reduce recurrent instability in on-track lesion cases
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Key takeaways:
- Bankart repair alone was associated with increased recurrent instability risk vs. Bankart repair with remplissage.
- Bankart repair alone was linked with higher revision risk vs. Bankart repair with remplissage.
SAN FRANCISCO — Bankart repair with remplissage reduces recurrent instability risk in patients with on-track Hill-Sachs shoulder lesions, according to results presented here.
“Observed risk reduction was particularly beneficial for high-risk patients,” Albert Lin, MD, FAAOS, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Lin and colleagues retrospectively reviewed data from 169 patients (mean age, 21.5 years) with on-track Hill-Sachs shoulder lesions who underwent either Bankart repair alone (n = 116) or Bankart repair with remplissage (n = 53).
Researchers determined that high-risk patients met the following criteria: a near-track Hill-Sachs on-track lesion, hyperlaxity, younger age, at least one preoperative instability episode, contact sports and glenoid bone loss of less than 15%.
Outcomes measured included rates of recurrent instability and revision surgery. Lin and colleagues also set out to develop a risk assessment tool for recurrent instability to help determine which patients would benefit from remplissage.
Overall, Lin said patients in the Bankart repair alone group were eight to 10 times more likely to report recurrent instability compared with the remplissage group. Lin also said that the Bankart alone group were nine times more likely to have revision surgery compared with the remplissage group.
In terms of independent risk factors, Lin and colleagues found that younger age, contact sports, hyperlaxity, near-track Hill-Sachs lesions, at least one preoperative instability episode and glenoid bone loss in non-contact athletes were associated with increased recurrent instability risk.
Lin added, “If you look at the risk factor burden, there were much higher rates of recurrent instability following a Bankart repair alone, and you can also confer a greater benefit of a remplissage when you have increasing risk burden.”
He concluded, “The Pittsburgh Instability Risk Assessment Score may help determine which patients may or may not benefit from remplissage or need a different surgical approach altogether.”
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