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Preoperative radiograph of the right shoulder showing true anteroposterior (AP) and axillary lateral views.
Source publication
Objective
To demonstrate whether arthroscopic remplissage can achieve good outcomes without significantly impairing shoulder function.
Methods
Consecutive patients with recurrent anterior glenohumeral dislocation, glenoid bone loss <20%, and engaging Hill–Sachs lesion who were operated with arthroscopic Bankart repair and remplissage between 2013...
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Citations
... Common surgical procedures include the Bankart and Latarjet procedures. Of these, the Bankart repair is the procedure of choice for most anterior shoulder instabilities, and it has yielded favourable outcomes in numerous studies [4][5][6]. However, for athletes at high risk of recurrent shoulder instability, such as those with ≥ 20% glenoid bone defects, the Bankart repair is still associated with a notable risk of recurrence [5,[7][8][9]. ...
Background
The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure.
Methods
The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications.
Results
After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%).
Conclusion
For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.
... On the opposite pole, the "off-track" concept [59], represented by an engaging Hill-Sachs lesion, revealed that it could frequently be managed through a posterior capsule and infraspinatus tenodesis-the remplissage procedure [62]. This approach provided promising results in averting recurrent anterior shoulder instability, boasting lower failure rates compared to the Bankart procedure alone, especially in cases of minimal glenoid bone loss [62][63][64]. Moreover, recent clinical findings have further encouraged the adoption of the remplissage procedure, as it has been associated with a reported absence of external rotation loss [64,65]. ...
... This approach provided promising results in averting recurrent anterior shoulder instability, boasting lower failure rates compared to the Bankart procedure alone, especially in cases of minimal glenoid bone loss [62][63][64]. Moreover, recent clinical findings have further encouraged the adoption of the remplissage procedure, as it has been associated with a reported absence of external rotation loss [64,65]. ...
The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.
Background and objective:
Anterior shoulder instability can be debilitating for young, active individuals, and increasing magnitudes of glenoid bone loss (GBL) predisposes patients to recurrent instability and increases the likelihood of failure of soft-tissue only repairs. It is widely accepted that GBL >25% should be treated with a glenoid bone grafting procedure. However, consensus is lacking on the optimal management in the setting of subcritical GBL, typically classified as >13.5%. This article reviews the pathoanatomy relevant to anterior shoulder instability and subcritical GBL, while highlighting existing evidence regarding open augmentation procedures in comparison to other treatment options for this subpopulation.
Methods:
A narrative review of the current literature was conducted focusing on subcritical GBL in anterior glenoid stabilization procedures, including review of forward citation and reference lists of selected articles.
Key content and findings:
Computed tomography (CT) is the modality of choice for obtaining precise measurements of subcritical GBL, defined as <13.5%, using the best-fit circle method. There is debate surrounding the optimal surgical management of subcritical GBL. Arthroscopic Bankart repair (ABR) remains the predominate surgery performed for primary anterior shoulder instability, while glenoid augmentation and open Bankart repair continue to be used sparingly in the United States. Historically, the Latarjet procedure was considered for substantial glenoid defects, but the illumination of subcritical GBL has expanded its indications. Arthroscopic, soft tissue-only repairs with the addition of remplissage, has been shown to have similar 2-year outcomes to the Latarjet in patients with >15% GBL, which has been limited in the study of subcritical GBL. Additionally, utilization of distal tibial allograft and local autograft is becoming increasingly prevalent. However, again, with limited prospective studies in the subcritical GBL population.
Conclusions:
There is no consensus regarding the optimal treatment approach to recurrent shoulder instability in the setting of subcritical GBL. Conversely, there is a growing agreement that isolated ABR is likely inadequate and subcritical GBL should prompt consideration of a more robust operation. To this end, interest in glenoid bone augmentation continues to grow as a reliable technique for recreating the native architecture and restoring glenohumeral stability are developed.
Purpose
The addition of the remplissage procedure to an arthroscopic Bankart procedure has been shown to improve clinical outcomes, yet at the expense of potentially decreasing shoulder range of motion. The purpose of this study was to assess recurrent instability, range of motion, functional outcomes and rates of return to sport outcomes in patients undergoing an isolated arthroscopic Bankart repair compared to those undergoing arthroscopic Bankart repair in addition to the remplissage procedure.
Methods
According to the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines, a search was conducted using three databases (MEDLINE/OVID, EMBASE and PubMed). Retrieved studies were screened based on predefined inclusion and exclusion criteria for comparative studies. Data were extracted and meta‐analysis performed using a random‐effects model.
Results
A total of 16 studies (13 level III studies, 2 level II studies and 1 level I) were included with a total of 507 and 704 patients in the Bankart plus remplissage and isolated Bankart repair groups, respectively. No studies reported glenoid bone loss of >20% with the least percentage of glenoid bone loss reported among studies being <1%. There was a significantly increased rate of recurrent dislocations (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.380–7.48, p < 0.00001) and revision procedures (OR = 3.36, 95% CI: 1.52–7.41, p = 0.003) in the isolated Bankart repair group compared to the Bankart plus remplissage group. Additionally, there were no significant differences between groups in terms of external rotation at side (n.s.), in abduction (n.s.) or at forward flexion (n.s.) at final follow‐up. Furthermore, return to preinjury level of sport favoured the Bankart plus remplissage group (OR = 0.54, 95% CI: 0.35–0.85, p = 0.007).
Conclusion
Patients undergoing arthroscopic Bankart plus remplissage for anterior shoulder instability have lower rates of recurrent instability, higher rates of return to sport, and no significant difference in range of motion at final follow‐up when compared to an isolated arthroscopic Bankart repair. Further large, prospective studies are needed to further determine which patients and degree of bone loss would benefit most from augmentation with the remplissage procedure.
Level of Evidence
Level III.
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.
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.
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.
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.
III.
OBJECTIVES The purpose of this study was to evaluate the effects of shoulder rehabilitation exercise on range of motion (ROM), muscle activity, muscle tone and manual muscle strength after arthroscopic bankart repair in elite collegiate rowing athlete.METHODS A 22-year-old elite collegiate rowing athlete with nerve decompression surgery for scapular entrapment syndrome in 2019, and arthroscopic bankart repair in 2021 was enrolled in this case study. Shoulder rehabilitation exercise program was received weight bearing and elastic band exercises, and was performed for 50 min/day, and 3 day/week for 8 weeks. ROM (flexion, extension, abduction, internal rotation, external rotation), muscle activity, muscle tone and manual muscle strength (infraspinatus; IFP, teres minor; TM, biceps; BI, lateral deltoid; LD, supraspinatus; SSP, upper trapezius; UT) were measured before, after 4 and 8 weeks of shoulder rehabilitation exercise.RESULTS Shoulder ROM increased at flexion, extension, abduction, internal rotation, external rotation after shoulder rehabilitation exercise. Muscle tone increased at IFP, TM, LD, SSP, and UT, but BI decreased after shoulder rehabilitation exercise. Muscle activity and manual muscle strength increased at IFP, TM, BI, LD, SSP, UT after shoulder rehabilitation exercise.CONCLUSIONS The results of this case report confirmed that shoulder rehabilitation exercise had a positive effect on the muscular physiological indices after arthroscopic bankart repair in elite collegiate rowing athlete.
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
