“…In revision surgery, there is no definite indication for each surgical method (revision Bankart repair or Latarjet procedure for failed Bankart repair), and the Latarjet procedure could be performed even if the glenoid bone defect is minimal or does not exist, demonstrating good results [30, 44]. In addition, the previous Bankart repair surgery is a risk factor for poor outcomes after both revision Bankart repair and Latarjet procedure, and the results of the two revision surgery may be less predictable than those of the primary surgery [52, 62].…”
PurposeThis study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair.
MethodsA literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non‐randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta‐analysis.
ResultsTwenty‐four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta‐analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9–80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8–88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta‐analysis.
ConclusionCompared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications.
IRB NoKUMC 2022–01‐024.
Level of evidenceLevel IV.
“…In revision surgery, there is no definite indication for each surgical method (revision Bankart repair or Latarjet procedure for failed Bankart repair), and the Latarjet procedure could be performed even if the glenoid bone defect is minimal or does not exist, demonstrating good results [30, 44]. In addition, the previous Bankart repair surgery is a risk factor for poor outcomes after both revision Bankart repair and Latarjet procedure, and the results of the two revision surgery may be less predictable than those of the primary surgery [52, 62].…”
PurposeThis study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair.
MethodsA literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non‐randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta‐analysis.
ResultsTwenty‐four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta‐analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9–80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8–88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta‐analysis.
ConclusionCompared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications.
IRB NoKUMC 2022–01‐024.
Level of evidenceLevel IV.
“… 29 , 33 One study was not a clinical trial. 24 Other studies were excluded for Spanish language, 37 inclusion of only revision surgery patients, 8 not providing comparison between the BR and Latarjet group. 17 Figure 1 PRISMA flow diagram visualizing the article selection process.…”
“…Similarly, in the subanalysis of patients undergoing revision stabilization surgery, the remplissage group had significantly higher recurrence rate (34.8% vs 10.3%) and higher pain scores. Other comparative studies that utilized remplissage in the setting of ≤ 15% glenoid bone loss have demonstrated comparable recurrence rates between groups but worse PROs and higher rates of subjective instability for patients who underwent BR + R [43,48,51].…”
Purpose of Review
Arthroscopic remplissage has continued to gain popularity as an adjunct to Bankart repair for patients with anterior shoulder instability. Although the original remplissage technique was described over 15 years ago, our understanding of when and how to use this procedure continues to evolve. This article provides a review of how remplissage affects shoulder biomechanics, compares clinical outcomes between remplissage and other procedures for shoulder instability, and discusses current indications for remplissage.
Recent Findings
Current research focuses on the use of remplissage across a wide range of glenoid bone loss. Remplissage appears effective at preventing recurrent instability in patients with glenoid bone loss up to 15% of the glenoid width. However, once glenoid bone exceeds 15%, outcomes tend to favor bony reconstruction procedures such as Latarjet. Results of biomechanical studies examining shoulder range of motion (ROM) after remplissage are mixed, though clinical studies tend to report no significant limitations in ROM when remplissage is added to a Bankart repair.
Summary
Adding a remplissage to conventional Bankart repair may improve clinical outcomes and lower rates of recurrent instability without significantly altering shoulder ROM. However, surgeons should recognize its limitations in treating patients with large amounts of glenoid bone loss and should be prepared to discuss alternative procedures on a case-by-case basis. Absolute indications and contraindications for remplissage are not well defined currently and require further scientific research.
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