What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study

Abstract

Background: Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). Hypothesis: There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. Results: At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction ( P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane ( P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors ( P = .003), increased patient age ( P = .02), and preoperative side-to-side deficits in ER ( P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness ( P = .04), with no association with remplissage ( P = .26). Conclusion: Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

“…32,66 Other management options, such as the Latarjet and other bone block procedures and the remplissage procedure, may have a lower recurrent instability rate but may also lead to complications such as reduced range of motion, altered anatomy complicating revision, nerve injury, and premature osteoarthritis. 18,22,24,36,40,62 This management dilemma has prompted extensive research with the goal of optimizing surgical techniques and refining indications to improve outcomes by matching the appropriate surgical procedure to the appropriate patient.…”

Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta‐analysis

“…A common point of contention within the recent literature relates to whether or not adding a remplissage, a nonanatomical procedure, to an arthroscopic Bankart repair results in a clinically important restriction of shoulder range of motion, specifically loss of ER, or patient dissatisfaction in the long term. Clinical, biomechanical, and cadaveric studies have shown that the addition of remplissage may cause loss of ER [44, 52–54]. In addition, in a RCT performed by MacDonald et al [45], the authors reported 10° loss of ER in abduction at 12‐month in patients who had undergone an additional remplissage procedure, yet found no significant difference at 24 months.…”

Combined Double-Pulley Remplissage and Bankart Repair

“… 13 , 31 , 34 , 35 , 37 The elevated Latarjet procedure complication rates can be attributed to various intraoperative and postoperative factors, namely vascular damage, neurological injuries, and hematoma. 34 Concerning additional clinical benchmarks for remplissage versus Latarjet, literature seems to suggest comparable to marginally higher return-to-sport rates, 7 , 28 reduced internal rotation motion (40.9° vs 53.2°), 35 increased risk of reduced external rotation motion with abduction, 38 , 39 and inconclusive results regarding postoperative pain, with a few studies hinting at neutral to higher marks. 13 , 35 , 39 , 40 Currently, a general lack of long-term follow-up studies regarding said clinical evaluations limit discussion specificity.…”