Summary

Hill-Sachs interval, number of anchors used in capsulotenodesis and time after operation are possible predictive factors of limitation of external rotation after combined Bankart repair and remplissage for anterior shoulder instability with off-track Hill-Sachs lesion and glenoid bone loss <20%.

Abstract

Purpose

Bankart repair and Remplissage (BRR) has been advocated for anterior shoulder instability with off-track Hill-Sachs lesion (HSL) and subcritical glenoid bone loss (<20%). The purpose of this study was to evaluate the functional results after BRR, with particular focus on external rotation (ER).

Methods

41 anterior shoulder instability patients with off-track HSL and glenoid bone loss <20% were treated with BRR and followed for a median of 23 months. Functional outcome was assessed using the American Shoulder and Elbow Surgeons score (ASES) and the Western Ontario Shoulder Instability Index (WOSI). Shoulder range of motion (ROM) was assessed and compared to the opposite side including forward flexion (FF), external rotation at the side (ERs), external rotation in abduction (ERa) and internal rotations in abduction (IRa). Patient demographics, sports participation, number of dislocations, duration of instability, length of follow up, glenoid track, Hill-Sachs interval (HSI), HSL depth and the number of anchors used for the remplissage were recorded for correlation with the results.

Results

All patients showed marked improvement in the postoperative WOSI and ASES scores compared to preoperative status by a mean difference of 46.1% ± 19.5 and 29.2 ± 13.3 respectively. The mean reduction in ERs, ERa, FF and IRa were (22.5% ± 16.18), (13.09% ± 8.2), (2.46% ± 1.92) and (10.12% ± 6.) respectively. ERs limitation was significantly associated with time of final follow up (P=<0.001, r= - 0.711), HSI (P= <0.001, r= 0.752), number of dislocations (p= 0.013, r= - 0.385), sport participation (p= 0.010) and number of remplissage anchors (p=0.004). ERa limitation was significantly associated with time of final follow up (P=<0.001, r= - 0.569), HSI (p= <0.001, r= 0.605) and number of remplissage anchors (p= 0.003). Regression analysis revealed 3 significant predictive factors for ER limitation including time of final follow up, HSI and number of anchors.

Conclusion

BRR results in good functional outcomes in patients with less than 20% glenoid bone loss and an off-track HSL. The results suggest that postoperative limitation in ER decreases overtime. Particular consideration and appropriate counselling should be undertaken in patients with large HSI and when more than one anchor for capsulotenodesis is anticipated due to an increased risk of ER limitation