To present our work, we have no disclosures related to this project. So arthroscopic repair of capsulolabral complex has become the most common intervention for recurrent anterior instability, but there's an increased risk of recurrent dislocation after repair in patients of younger age, those that participate in competitive contact or overhead sports, hyperlaxity, and radiographic findings of glenoid bone loss and or Hill Sachs lesion. The Hill Sachs lesion has been identified as a common pathology and has been found to be significantly associated with recurrent instability. And as was just presented, the importance of bony defects play in recurrent instability following soft tissue procedures led to the concept of the engaging Hill Sachs lesion with the evolution of the on-track, off-track lesions further highlighted the role of bone defects in post-op failure. So the term remplissage translated from French means to fill in, and the arthroscopic remplissage was first described by Wolf and Purchase, was thought to prevent the engagement phenomena by making the Hill Sachs defect extra-articular. Our research group conducted a randomized trial beginning in 2011 comparing remplissage versus no remplissage with anterior shoulder stabilization in patients with traumatic recurrent shoulder instability. A Hill Sachs lesion confirmed on CT or MRI and less than 15% glenoid bone loss. The endpoint for that original trial was two years post-op, and we found no differences in our patient-reported outcomes, but there was a difference in recurrent instability in favor of remplissage at 18% versus 4%. So this provided support for the benefits of remplissage in the short term, but its effectiveness in preventing late failures remained unclear. The aim of the current study was to compare medium-term outcomes of patients previously randomized, the rate of recurrent instability, and instances of reoperation were examined. The original study was double-blind RCT with two parallel groups conducted at two sites between 2011 and 2017. In early 2020, an attempt was made by a blind assessor to contact all patients by phone. Patients were asked a series of standardized questions regarding instances of subluxation or dislocation on the affected side and dates of these occurrences. And they were asked if they had undergone any additional surgeries and a chart review was done. We defined failure as a recurrence of a dislocation and recurrent instability was defined as the participant reporting a dislocation or two or more occurrences of subluxation sometime after the first year post-op. So here's the demographics of the two groups which were comparable based on sex, age, BMI, and the proportion that played contact sports. The mean number of months from surgery to follow-up was 49.3 for the no-REMP group and 53.8 for the REMP group. 11 of 50 in the no-REMP group dislocated in an average of 16 months post-op compared to 4 of 52 in the REMP group at an average of 24 months. 15 of 50 in the no-REMP group had recurrent instability at an average of 11 months compared to 5 of 52 in the REMP group at an average of 16 months. So based on Kapler-Meier survival curve analyses, we found a significant difference between groups for dislocation favoring REMPlessage as you can see by the diverging lines here. And this was also the case for recurrent instability as seen here. As in our original study, we also conducted a sub-analysis of those that we deemed high risk for re-injury with the hill sacks greater than or equal to 15% of the humeral head diameter or a width greater than or equal to 2 centimeters. And once again the results favored having undergone a REMPlessage. Looking at re-operations, we also looked at re-operations and those that did not undergo REMPlessage had higher incidence of re-operation than those that did. So in summary, those that did not undergo REMPlessage had higher rates of recurrence, earlier time to recurrence, and higher rate of re-operation. And at medium-term follow-up REMPlessage in conjunction with arthroscopic Bankart repair results in lower risk of post-op recurrent instability and dislocation compared to those who undergo Bankart repair alone. Thank you.

arthroscopic repair

recurrent anterior instability

remplissage

Hill Sachs lesion

shoulder stabilization