Remplissage reduced sense of apprehension and increased the rate of return to sports at preinjury level of elite overhead athletes with on-track anterior shoulder instability

PURPOSE

The purpose of this study was to compare the results of arthroscopic isolated Bankart repair (B) with Bankart repair plus Remplissage (B + R) procedure in contact overhead athletes with on-track anterior shoulder instability.

METHODS

A total of 64 athletes playing basketball, volleyball and handball in elite professional level who underwent arthroscopic isolated Bankart repair (34 patients) or Bankart repair plus Remplissage procedure (30 patients) with the diagnosis of recurrent anterior shoulder instability between 2017 and 2020, were retrospectively reviewed. Radiologically all patients had on-track Hill-Sachs defects and minimal or subcritical glenoid bone loss (< 13.5%). Patients were evaluated using pre- and postoperative pVAS, SANE, ASES, ROWE, WOSI scores and postoperative active ROM assessment. Patients were also asked for the frequency of any subjective apprehension and satisfaction with the surgery in four grades.

RESULTS

The mean ages of the groups B and B + R were 26.8 and 26 years (SD = 3.22), respectively; the mean follow-up times were 37.8 and 36.2 months (SD = 11.19). Compared with the preoperative status, there was a statistically significant improvement of all 5 postoperative outcome scores in both groups (P < 0.001). However, significant difference between the improvement of the groups were only found for the SANE (B: 22.3 ± 4.1, B + R: 26.3 ± 4.3; P = 0.0004), ASES (B: 26.1 ± 2.6, B + R: 30.2 ± 3.6; P < 0.001) and ROWE (B: 42 ± 3.7, B + R: 47.7 ± 2.8; P < 0.001) scores in favor of the group B + R. The loss of internal and external rotation of the adducted arm in group B + R was found to be approximately 5 degrees compared to the group B (P < 0.001). More than 80% of group B + R showed no apprehension in sports activities and almost completely returned to pre-injury athletic level, depicting statistically significant improvement compared to group B athletes (P = 0.002 and 0.036, respectively). 3 patients developed re-dislocation after isolated Bankart repair, whereas no re-dislocation occurred in the B + R group.

CONCLUSION

Adding Remplissage procedure to the Bankart repair provided an advantage in terms of both return to sport at preinjury level and the frequency of apprehension sensation during sports activity.

LEVEL OF EVIDENCE

III.

The glenoid track: a review of the clinical relevance, method of calculation and current evidence behind this method

In the setting of bipolar bone injury, orthopedic surgeons are currently making use of the glenoid track method to guide surgical management. Using preoperative CT or MR imaging, this method allows the identification of patients who are more likely to fail a primary capsuloligamentous Bankart repair. As the glenoid track method becomes increasingly used in preoperative planning, it is important for the radiologist to become familiar with its concept and method of calculation. This review article aims to concisely summarize the current literature and the clinical implications of the glenoid track method.

Bipolar bone defect in the shoulder anterior dislocation

In the anterior shoulder instability with glenoid bone loss among 25 % or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting (Latarjet procedure) should be performed. The engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior shoulder instability. We have developed a method using radiographic and arthroscopic studies and the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior shoulder instability (first dislocation or recurrent dislocation), both with and without bipolar bone loss.