ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage

Zheci Ding, MD, Shanghai CHINA
Jiwu Chen, MD, PhD, Shanghai CHINA

Huashan Hospital, Fudan University, Shanghai, CHINA

FDA Status Not Applicable

Summary

The glenohumeral cartilage degeneration (higher signal intensity) after Arthroscopic Bankart Repair and Remplissage had a significantly positive correlation with the postopertive loss in external rotation, which was found to be associated with relatively medial placement of remplissage anchor.

Abstract

Background

No study has reported clinical evidence for cartilage change in the glenohumeral joint or the cause of loss in range of motion (ROM) after arthroscopic Bankart repair with remplissage technique (BR).

Purpose

To investigate the postoperative features of glenohumeral joint cartilage, ROM, and anchor placement for remplissage at a minimum of 2 years of follow-up after BR and to analyze the correlations.

Methods

A total of 21 patients who underwent BR received follow-up for a minimum of 2 years. At both preoperative assessment and final follow-up, passive shoulder ROM, Oxford Shoulder Instability Score, Simple Shoulder Test score, and Single Assessment Numerical Evaluation score were assessed. All patients underwent 3.0-T magnetic resonance imaging (MRI) examination at final follow-up. The clinical outcomes, glenohumeral cartilage or Hill-Sachs lesion–related MRI parameters, and their potential correlations were analyzed.

Results

The mean follow-up was 55.0 months (range, 24-119 months). Compared with preoperative assessment, all functional scores significantly improved (P< .001). At the final follow-up, a significant ROM loss (>15°) of external rotation (ER) at the side (ER0) was found in 12 patients, among whom 8 patients had significant ROM loss of ER at 90° of abduction as well. Further, 12 patients with decreased ER had significantly higher signal intensity of cartilage on the anterior, middle, and posterior humeral head (anterior, P = .002; middle, P<.001; posterior, P<.001) than 9 patients with normal ER. The ratio of the width of the remplissage anchor to the diameter of the humeral head (w:d ratio) was significantly greater (P = .031) in the decreased ER group than in the normal ER group. Correlation analysis showed that signal intensity on the posterior humeral head and ER0 loss (deltaER0) had a significantly positive correlation (r = 0.516; P = .034), while the w:d ratio and deltaER0 had a significantly positive correlation (r = 0.519; P = .039).

Conclusion

At a minimum of 2 years of follow-up, patients who underwent BR showed significant clinical improvement compared with preoperative assessment, except for limitations in ER. The glenohumeral cartilage degeneration (higher signal intensity) after BR had a significantly positive correlation with the postoperative ER loss, which was found to be associated with a relatively medial placement of the remplissage anchor.

Keywords: shoulder instability; arthroscopy; Bankart repair; remplissage; articular cartilage

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