AJSM Webinar Series: Management of Anterior Shoulder Instability: A Highlight of the Top 4 Articles in AJSM (2024 to 2025) - Recording-MacDonald - Arthroscopic Bankart Repair With Remplissage in Anterior Shoulder Instability

MacDonald - Arthroscopic Bankart Repair With Remplissage in Anterior Shoulder Instability

Pdf Summary

This medium-term follow-up study (mean 4 years) of a randomized controlled trial investigated the efficacy of arthroscopic Bankart repair with remplissage (REMP) versus isolated Bankart repair alone (NO REMP) in treating recurrent anterior shoulder instability associated with a Hill-Sachs lesion and subcritical glenoid bone loss (<15%). The original trial (2011-2017) included 108 patients randomized to either NO REMP or REMP groups, both undergoing arthroscopic repair but with the REMP group receiving an additional remplissage procedure that fills the Hill-Sachs defect using the infraspinatus tendon and posterior capsule to prevent engagement and reduce instability.<br /><br />At medium-term follow-up, failure rate defined as redislocation was significantly lower in the REMP group (8%) than in the NO REMP group (22%), with REMP patients also experiencing redislocations later postoperatively (mean 24 vs. 17 months). Overall recurrent instability—which included redislocations and ≥2 subluxations after 1 year—was 10% in REMP vs. 30% in NO REMP patients. Survival analyses showed significantly better outcomes favoring remplissage. Revision surgeries were more frequent in the NO REMP group, commonly involving Latarjet procedures.<br /><br />Subgroup analyses revealed that patients at higher risk of reinjury, defined by larger Hill-Sachs lesions (>15% humeral head diameter or width >2 cm) or participation in contact sports, particularly benefited from remplissage with fewer redislocations and instability episodes.<br /><br />The findings support that adding remplissage to Bankart repair significantly reduces the rate and delays recurrence of shoulder instability compared to Bankart repair alone, sustaining benefits observed at 2 years out to a medium-term of ~4 years. Given the safety profile and lower reoperation rates compared to bony augmentation procedures, remplissage is recommended in patients with engaging Hill-Sachs lesions and limited glenoid bone loss as an effective surgical strategy for managing anterior shoulder instability.<br /><br />Limitations include reliance on patient self-report for instability events and heterogeneity in surgeon technique and follow-up. Nonetheless, this study provides level 1 evidence affirming the durability and superiority of Bankart repair combined with remplissage over isolated Bankart repair in preventing recurrent anterior shoulder instability.

Keywords

arthroscopic Bankart repair

remplissage

anterior shoulder instability

Hill-Sachs lesion

glenoid bone loss

recurrent instability

randomized controlled trial

redislocation rate

contact sports injury

revision surgery