Is Revision Bankart Repair with Remplissage a Viable Option for Failed Bankart Repair in Non-contact Sports Person Aiming to Return to Sports?

Is Revision Arthroscopic Bankart Repair a Viable Option? A Systematic Review of Recurrent Instability following Bankart Repair

Background/Objectives: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of arthroscopic revision Bankart repair. Methods: Following the PRISMA guidelines and registered on PROSPERO, this systematic review examined twenty-five articles written between 2000 and 2024. Two independent reviewers assessed eligibility across three databases, focusing on recurrent instability as the primary endpoint, while also noting functional measures, adverse events, revision operations, and return-to-sport rates when available. Results: The key surgical techniques for recurrent instability post-Bankart repair were identified, with revision arthroscopic Bankart being the most common (685/1032). A comparative analysis revealed a significantly lower recurrence for open coracoid transfer compared to arthroscopic revision Bankart repair (9.67% vs. 17.14%; p < 0.001), while no significant difference was observed between remplissage plus Bankart repair and Bankart repair alone (23.75% vs. 17.14%; p = 0.24). The majority of studies did not include supracritical glenoid bone loss or engaging Hill-Sachs lesions, and neither subcritical nor non-engaging lesions significantly influenced recurrence rates (p = 0.85 and p = 0.80, respectively). Conclusions: Revision arthroscopic Bankart repair remains a viable option in the absence of bipolar bone loss; however, open coracoid transfer appears to have lower recurrence rates than arthroscopic Bankart repair, consistent with prior evidence. Further studies should define cutoffs and investigate the roles of critical glenoid bone loss and off-track Hill-Sachs lesions. Preoperative measurements of GBL on three-dimensional computed tomography and characterizing lesions based on glenoid track will help surgeons to choose ideal candidates for arthroscopic revision Bankart repair.

Arthroscopic Remplissage Combined With Bankart Repair Results in a Higher Rate of Return to Sport in Athletes Compared With Bankart Repair Alone or the Latarjet Procedure: A Systematic Review and Meta-analysis

BACKGROUND

Traumatic anterior shoulder instability affects athletes at a higher rate compared with the general population. In recent years, indications for arthroscopic remplissage, an adjunct procedure classically used to reduce the recurrence of anterior shoulder instability in patients with off-track Hill-Sachs lesions, have expanded.

PURPOSE

To investigate return-to-sport (RTS) rates, functional outcomes, and adverse events in athletes who underwent arthroscopic Bankart repair with remplissage compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 4.

METHODS

A literature review of the Embase, PubMed (MEDLINE), and Web of Science databases was conducted for articles published before May 22, 2022. For the systematic review, 16 of 457 studies that reported RTS rates at any time point after remplissage were deemed eligible for inclusion in quantitative analysis and 17 of 457 studies in qualitative analysis. For the meta-analysis, 8 of 457 studies reported RTS rates after remplissage compared with surgical alternatives including Bankart repair alone or the Latarjet procedure and were deemed eligible for inclusion.

RESULTS

In total, 538 athletes underwent remplissage and were included in the study. RTS at any level was achieved by 86% (395/457) of patients, and the odds of RTS at any level were significantly higher after remplissage compared with surgical alternatives (odds ratio [OR], 2.71 [95% CI, 1.14-6.43]; P = .02). The odds of RTS at a previous or higher level were also significantly higher after remplissage compared with surgical alternatives (OR, 2.07 [95% CI, 1.29-3.31]; P = .002). The mean Rowe score increased significantly from 43.9 ± 7.77 preoperatively (n = 173) to 92.2 ± 4.02 after remplissage (n = 397) (P < .001), but there was no significant difference in Rowe scores between remplissage and surgical alternatives (P = .54). After remplissage, the recurrence rate was 5.0% for athletes (n = 220) and 7.3% for all patients (n = 634), with a mean time to recurrence of 24.0 ± 12.5 months. Reoperations occurred in 3.6% of athletes (n = 110) and 4.1% of all patients (n = 445). Recurrence and reoperations were significantly less likely after remplissage compared with surgical alternatives (OR, 0.18 [95% CI, 0.08-0.39]; P < .001 and OR, 0.17 [95% CI, 0.06-0.50]; P = .001, respectively).

CONCLUSION

Arthroscopic Bankart repair with remplissage augmentation significantly improved RTS rates among athletes, both at any level and at previous levels of play. Additionally, remplissage appeared to significantly decrease recurrence and reoperation rates compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure.

Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis

PURPOSE

This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair.

METHODS

A 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.

RESULTS

Twenty-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.

CONCLUSION

Compared 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 NO

KUMC 2022-01-024.

LEVEL OF EVIDENCE

Level IV.

Return to Sport After Arthroscopic Bankart Repair With Remplissage: A Systematic Review

PURPOSE

To determine the return-to-sport rate following arthroscopic Bankart repair with remplissage (ABR), including overall rate of return to sport, rate of return to preinjury level of sport, and the rate of return for specific subgroups such as contact or throwing athletes.

METHODS

EMBASE, PubMed, and MEDLINE were searched from database inception until February 2022. Studies were screened by 2 reviewers independently and in duplicate for data regarding rates of return to sport following ABR. Data on return to sport and functional outcomes were recorded. Data are presented in a descriptive fashion.

RESULTS

Overall, 20 studies were included with a total of 736 patients (738 shoulders) who underwent ABR. These patients had a mean age of 28 years (range 14-72 years) and were 83% male. Mean follow-up time after surgery was 45 months (range 12-127 months). The rate of return to any level of sport ranged from 60% to 100%, whereas the rate of return to the preinjury level ranged from 63% to 100%. When we excluded those who underwent ABR as a revision procedure, the rate of return to any level of sport was 68% to 100%. Lastly, the return to sport rates for contact or collision athletes ranged from 80% to 100%, whereas for overhead or throwing athletes it was 46% to 79%. The rate of recurrence of instability postoperatively ranged from 0% to 20% in included studies.

CONCLUSIONS

For athletes with anterior shoulder instability, ABR led to a high rate of return to sport along with a low rate of recurrence of instability. Although most athletes are able to return to the same level of sport, certain groups such as throwing athletes may face greater difficulty.

LEVEL OF EVIDENCE

Level IV, systematic review of Level III and IV studies.

Arthroscopic Remplissage Using Knotless, All-Suture Anchors

Glenohumeral bone loss is a significant risk factor for recurrent instability after shoulder dislocation. The Hill-Sachs lesion is an osseous defect of the posterior humeral head that is commonly recognized after anterior shoulder dislocation. Several procedures exist to address humeral-sided bone loss, including soft tissue filling procedures, osteoarticular allografts, bone plugs, rotation osteotomies, and humeral head replacements. However, among the most common of these procedures is the arthroscopic remplissage. This technique involves capsulotenodesis of the posterior shoulder capsule and infraspinatus tendon into a Hill-Sachs lesion. Previously described techniques use knotted suture anchors. In this report, we describe a modified technique for remplissage using knotless, all-suture anchors to perform capsulotenodesis of a Hill-Sachs lesion. Benefits of this technique include a single skin incision, improved bone preservation, and easier facilitation of revision surgery if required.