Modified Arthroscopic Remplissage Procedure For Traumatic Anterior Shoulder Instability With Head Hill-Sachs Lesion

Traumatic anterior shoulder instability with bony glenohumeral defect is one of the biggest problems for orthopaedic surgeon. Many evidences were showed that it can’t be solved only by traditional shoulder stabilization. Bristow-Latarjet procedure addresses appropriately the glenoid bone loss, as well as increases the articular arc preventing the potential engaging between humeral bone loss and anterior rim of glenoid, whereas the complications such as nonunion of bone, difficulty of revision and loss of range of motion are still can’t be avoided. Arthroscopic labral repair combined with Remplissage procedure has been proven effectively for traumatic anterior shoulder instability with Hill-Sachs lesion. But the potential possibility of loss of range of motion is still controversial. First, we performed a meta-analysis to evaluate whether Bristow-Latarjet procedure may address all types of traumatic anterior shoulder instability. Secondly, we modified the Remplissage technique as inserting the posterior capsules rather than infraspinatus tendon and posterior capsules into the humeral defect, besides, the anchor was implanted close to the superior margin of the defect to minimize the restriction of range of motion. A retrospective case controlled study were taken to determine whetherthis modified arthroscopic Remplissage procedure may address traumatic anterior shoulder instability with Hill-Sachs lesion without affecting the range of motion postoperative. Objective To evaluate the literature to determine whether Bankart repair or Bristow-Latarjet procedure for traumatic anterior shoulder instability results in a better clinical outcome.Methods A search involved all randomized controlled trails or non-randomized controlled trail that compared Bankart repair to Bristow-Latarjet procedure in PubMed (all language,1966to December2011), Ovid/EMbase (all language,1974to December2011) and Ovid/MedLine (all language,1946to December2011). The search strategy was "shoulder AND Latarjet OR Bristow OR Bankart". The outcome index such as recurrence rate, shoulder function scores and range of motion were extracted and analyzed by RevMan.Results The search terms resulted in2480results and only3non-randomized controlled trails met all of the inclusion criteria. There were147patients in the Bankart repair group and157patients in Bristow-Latarjet group. No significant statistic differences were showed when comparing the recurrence rate, Rowe score and external rotation postoperative [recurrence rate:RR=1.18,95%CI (0.50-2.79); Rowe core:RR=1.12,95%CI (0.96-1.29); external rotation:RR=1.03,95%CI (0.64-1.68)].Conclusion The data in the published literature do not support that Bristow-Latarjet procedure can address better clinical outcome. We do not suggest using this technique in all types of traumatic anterior shoulder instability. Objective To determine if a modified arthroscopic Remplissage procedure would address traumatic anterior shoulder instability with mild to moderate Hill-Sachs lesion without affecting the range of motion post-operatively.Methods A retrospective study of2groups (arthroscopic Bankart repair plus Remplissage procedure (Group A) versus arthroscopic Bankart repair plus modified Remplissage procedure (Group B)) were undertaken.52patients completed the follow up more than2years. Group A included24patients and Group B included28patients. All patients underwent the OSIS and Rowe score before and after operations. The ROM of affected limb was compared too.ResultsThe failure rate was4.2%(1/24) in Group A while no re-dislocation occurred in Group B. The OSIS in Group A improved significantly from37.0±4.4preoperatively to17.5±3.024months after surgery. In Group B, it increased from38.1±4.1to15.5±2.6. The Rowe score were19.4±7.6in Group A and19.3±5.7in Group B preoperative, and they were increased to86.9±8.7and92.5±7.0postoperative. Differences were statistically significant in both OSIS score and Rowe score (p=0.012for OSIS, p=0.013for Rowe score) between groups. There were no differences in forward flexion and internal rotation between or within groups but the loss of external rotation in Group B (1.7°) was significant less than Group A (11.4°)ConclusionArthroscopic modified Remplissage procedure may address traumatic anterior shoulder instability with mild to moderate Hill-Sachs lesion appropriately and minimize the restriction of range of motion postoperative.