Long-term results of arthroscopic Bankart repair with remplissage

Objectives: Arthroscopic Bankart repair with Hill-Sachs remplissage (BHSR) is suggested to treat anterior shoulder instability when there is an engaging humeral lesion. The objective of this study was to report the long-term clinical and radiological results of this procedure. Methods: This is a retrospective monocentric study including patients who underwent surgery for anterior shoulder instability by BHSR, seen again within a minimum of 5 years. 70% of the 51 patients (mean age 26 years; 16 - 49; ± 8.453 years) practiced sports. The mean ISIS score was 3.306 (0 - 7; ± 1.798). At the last follow-up, active range of motion, Subjective Shoulder Value (SSV), and Walch-Duplay and Rowe scores were measured. A radiographic assessment enabled the evaluation of arthrosis according to Samilson’s classification. Results: At a mean clinical follow-up of 86.8 months (60.0 - 123.9 ± 17.0 months), 83% of the patients had resumed sports activities. The mean Rowe, Walch-Duplay and SSV scores were 88.8 points (51-100; ± 12.4), 82.6 points (50 - 100; ± 16.4) and 87.9% (50 - 100, ± 8.5), respectively. 8 patients (15.6%) had a recurrence of dislocation or incomplete dislocation. In univariate analysis, patients who were stable at the last follow-up had a significant mean decrease in external rotation in adduction of 7° (p = 0.02) and in abduction of 6° RE2 (p = 0.006), a shallower Hill-Sachs (18% vs 25% of the humeral head diameter; p = 0.04), and were older (27 vs 19 years, p = 0.04). Radiographically, 84% of the patients had no osteoarthritis progression, while 13% had grade I osteoarthritis progression. Conclusion: BHSR allows resumption of sports activity in the majority of cases, with minor limitation of external rotation. However, the high failure rate in more than 5 years suggests that this procedure should be proposed with caution in case of a deep Hill-Sachs in young subjects.