Mid-term results of arthroscopic Bankart repair and remplissage for recurrent anterior shoulder instability in patients with a history of seizures

Abstract

Background Seizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures. Methods In this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score. Results The mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5). Conclusion In patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.

Latarjet operation carries three times the risk of failure in seizure versus non-seizure recurrent anterior dislocation of the shoulder joint: outcome of a systematic review with meta-analysis

“…1 shows the reasons for study exclusion. We analyzed 11 qualitative analyses [ 3 , 6 , 9 , 10 , 12 , 13 , 15 , 16 , 19 , 20 , 22 ] and three meta-analyses [ 6 , 9 , 10 ]. The PRISMA flow diagram for this review also is presented in Fig.…”

“…Based on the type of treatment reported in the included reports, we divided the selected studies into four groups: group 1: soft tissue procedure (Bankart’s operation with remplissage [ 12 ], group 2: Latarjet and Bristow operations [ 3 , 6 , 9 , 10 , 16 ], group 3: bone block operations (autograft and allograft) [ 13 , 15 ], and group 4: arthrodesis [ 18 , 19 ] and arthroplasty [ 20 , 22 ].…”

“…One retrospective cohort study investigated the effects of Bankart operation with remplissage in SD-associated RASD [ 12 ]. The patients in that study had medically controlled epilepsy, were free from SD for at least 1 year [ 12 ], and underwent surgery at a mean of 25.4±3.8 months (18–32 months) after their last SD episode.…”

“…One retrospective cohort study investigated the effects of Bankart operation with remplissage in SD-associated RASD [ 12 ]. The patients in that study had medically controlled epilepsy, were free from SD for at least 1 year [ 12 ], and underwent surgery at a mean of 25.4±3.8 months (18–32 months) after their last SD episode. The minimum follow-up of the included cases was 2 years, and all included patients experienced an average glenoid bone loss of 12.1%±8.9% (0%–18%) on computed tomography (CT) imaging.…”

“…Another study examined the outcomes of bone block operation in 13 epileptic patients/15 shoulders [ 13 ]. The study investigators used larger bone grafts compared to Eden-Hybinette procedure to create a smooth anterior extension of the glenoid [ 12 ]. The study included a mean of 46 (4–120) dislocations per shoulder before the bone block operation [ 13 ].…”