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

MacDonald - Arthroscopic Bankart Repair With Remplissage in Anterior Shoulder Instability

Pdf Summary

This randomized controlled trial compared medium-term (3 to 9 years, mean ~4 years) outcomes of arthroscopic Bankart repair alone (NO REMP) versus Bankart repair with remplissage (REMP) for recurrent anterior shoulder instability in patients with traumatic engaging Hill-Sachs lesions and subcritical (<15%) glenoid bone loss. Originally recruiting 108 patients (50 NO REMP, 52 REMP), participants were surveyed by telephone to assess redislocations, subluxations, and reoperations since surgery.<br /><br />Findings demonstrated significantly fewer redislocations and overall recurrent instability (redislocation or ≥2 subluxations >1 year postoperative) in the REMP group. Redislocation rates were 8% for REMP versus 22% for NO REMP, with redislocations occurring later in the REMP group (mean 23.8 vs 16.5 months). Overall recurrent instability rates were 10% for REMP versus 30% for NO REMP. Kaplan-Meier survival analysis showed a significant benefit favoring REMP. Subgroup analysis of high-risk patients with larger Hill-Sachs lesions or contact sports participation similarly demonstrated significantly lower failure rates with remplissage. Reoperation rates were higher in NO REMP, primarily involving Latarjet procedures after failure.<br /><br />The remplissage technique, involving arthroscopic filling of the Hill-Sachs defect by infraspinatus tendon and posterior capsule, stabilizes the joint by preventing lesion "engagement" and providing a posterior restraint, thereby reducing stress on the anterior capsule repair. The study corroborates earlier 2-year findings showing remplissage’s superiority in reducing recurrent instability without compromising subjective outcomes or shoulder motion.<br /><br />Limitations include reliance on patient-reported recurrence without clinical verification, absence of functional or radiographic assessments, and incomplete uniform follow-up times. Nonetheless, this level 1 evidence supports the use of Bankart repair with remplissage over isolated Bankart repair for traumatic anterior shoulder instability with engaging Hill-Sachs lesions and <15% glenoid bone loss, yielding lower rates of recurrent instability, later failure, and fewer revision surgeries at medium-term follow-up.

Keywords

Arthroscopic Bankart repair

Remplissage technique

Recurrent anterior shoulder instability

Traumatic engaging Hill-Sachs lesions

Subcritical glenoid bone loss

Redislocation rates

Recurrent instability

Kaplan-Meier survival analysis

Latarjet procedure

Medium-term clinical outcomes