Does “Remplissage” Procedure Modify Shoulder Mobility after Arthroscopic Bankart Repair?

Authors: Geoffroy Nourissat, Alexandre S Kilinc, Levon Doursounian

References: Presented at ICSES 2010

Introduction: Hill Sachs lesion is considered as one of the reasons of failure after arthroscopic bankart repair, because it is responsible for an engaging mechanism during external rotation. Wolf proposes to fill the defect with the tendon under arthroscopy. The aim of this paper is to evaluate, in a prospective study, with a minimum one year follow up, how the remplissage procedure modifies the shoulder mobility.

Material and methods: 32 patients underwent an arthroscopic stabilization of the shoulder over a 12 month period. using ISIS score, 17 patients had a Bankart Repair Alone (BRA) and 15 had a Bankart repair and a Hill Sachs "Remplissage"(BRR) during the same procedure. Patients were followed prospectively with a Walch Duplay and a Rowe score at 6 and 1 year. External rotations RE1 and RE2, forward elevation and abduction were collected and compared to the opposite side. Failure of the stabilization was noted. 10 patients of the "Remplissage" group had imaging of there shoulder.

Results: At one year, in the BRR, one patient had a dislocation during an epileptic crisis. In the BRA, one patient had a recurrent dislocation, one a capsulitis. Rowe and Walch Duplay score were excellent in both groups for patients without recurrence. In both groups, RE1 range from 30 to 85, RE2 from 40 to 85; forward elevation from 100 to 140 and abduction from 80 to 110. There was no statistically significant difference with the opposite shoulder mobility. At one year, 2 patients have mild pain at the entry portal of posterior anchors. MRI and arthroCT scan suggest that the tendon transfer healed in all cases.

Conclusion: The current study demonstrates that using ISIS score for inclusion criteria, the "Remplissage" procedure does not impair mobility of the shoulder one year after surgery.


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