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Off-track Hill–Sachs lesions do not increase postoperative recurrent instability after arthroscopic Bankart repair with selective Remplissage procedure

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to compare clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure, between patients with off-track and on-track Hill–Sachs lesions.

Methods

Patients who underwent arthroscopic Bankart repair with selective Remplissage procedure for recurrent anterior shoulder instability and were followed up for at least 2 years were included. Patients with a glenoid defect greater than 25% were excluded. According to the glenoid track concept, patients were divided into group I (off-track lesions) and group II (on-track lesions). After Bankart repair, an additional Remplissage procedure was performed selectively in patients who sustained engagement of the humeral head. The clinical outcomes and recurrence rates were evaluated.

Results

A total of 193 patients (23 in group I and 170 in group II) were enrolled. No significant differences were found in clinical outcomes (n.s.) or recurrence rates (n.s.) between the two groups, despite larger glenoid defects in group I (group I:17.1 ± 6.1%, and group II:13.0 ± 6.4%, P = 0.003). In all patients, the incidence of off-track lesions was not significantly different according to the occurrence of postoperative recurrence (n.s.), whereas the glenoid defect size showed a significant difference (with recurrence: 17.9 ± 3.9%, and without recurrence: 13.2 ± 6.5%, P = 0.002).

Conclusions

The presence of an off-track lesion did not alter the clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure. The glenoid defect size rather than the presence of an off-track lesion can more reliably predict postoperative recurrence. Arthroscopic Bankart repair with selective Remplissage procedure is considered one surgical option for the treatment of off-track lesions.

Level of evidence

III.

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Acknowledgements

The manuscript has been read and approved by all authors, and each author believes that the manuscript represents honest work.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (NRF-2016R1D1A1A09919541).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea

    In Park, Jun-Seok Kang, Yoon-Geol Jo, Sang-Woo Kim & Sang-Jin Shin

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  1. In Park
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Correspondence to Sang-Jin Shin.

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Conflict of interest

Sang-Jin Shin has received research grants from the National Research Foundation of Korea (NRF) grant funded by the Korea government. In Park, Jun-Seok Kang, Yoon-Geol Jo, and Sang-Woo Kim declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board of Ewha Womans University approved this study (IRB no: EUMC 2018-05-005).

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Park, I., Kang, JS., Jo, YG. et al. Off-track Hill–Sachs lesions do not increase postoperative recurrent instability after arthroscopic Bankart repair with selective Remplissage procedure. Knee Surg Sports Traumatol Arthrosc 27, 3864–3870 (2019). https://doi.org/10.1007/s00167-019-05441-2

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