Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis

Eoghan T Hurley; James P Toale; Martin S Davey; Christopher A Colasanti; Leo Pauzenberger; Eric J Strauss; Hannan Mullett

doi:10.1016/j.jse.2020.06.021

Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis

J Shoulder Elbow Surg. 2020 Dec;29(12):2487-2494. doi: 10.1016/j.jse.2020.06.021. Epub 2020 Jul 7.

Authors

Eoghan T Hurley¹, James P Toale², Martin S Davey², Christopher A Colasanti³, Leo Pauzenberger⁴, Eric J Strauss³, Hannan Mullett⁴

Affiliations

¹ Sports Surgery Clinic, Dublin, Ireland; Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: eoghanhurley@rcsi.ie.
² Sports Surgery Clinic, Dublin, Ireland; Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
³ New York University Langone Medical Center, New York, NY, USA.
⁴ Sports Surgery Clinic, Dublin, Ireland.

PMID: 32650087
DOI: 10.1016/j.jse.2020.06.021

Abstract

Background: The purpose of this study was to perform a systematic review and meta-analysis of the current evidence in the literature to determine how arthroscopic Bankart repair (ABR) and remplissage compare with ABR alone and the open Latarjet procedure for anterior shoulder instability in patients with concomitant Hill-Sachs lesions.

Methods: A literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies comparing ABR and remplissage vs. ABR alone or the Latarjet procedure for anterior shoulder instability in patients with Hill-Sachs lesions were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). P < .05 was considered statistically significant.

Results: Twelve clinical trials were included. There was a significant difference between ABR plus remplissage and ABR alone in total recurrence rate (3.2% vs. 16.8%, P < .05) but not the rate of revision due to recurrence (1.7% vs. 8.5%, P = .06). There was no significant difference between the Latarjet procedure and ABR plus remplissage in total recurrence rate (7.0% vs. 9.8%, P = .39), total revision rate (3.7% vs. 5.7%, P = .41), and rate of revision due to recurrence (1.6% vs. 2.1%, P = .79). There was a significantly lower rate of complications with ABR and remplissage compared with the Latarjet procedure (0.5% vs. 8.6%, P = .003).

Conclusion: In patients with Hill-Sachs lesions and subcritical glenoid bone loss, ABR with remplissage resulted in lower rates of recurrent instability compared with ABR alone while resulting in similar recurrence rates, as well as similar patient-reported outcomes, with lower morbidity and fewer complications, compared with the Latarjet procedure.

Level of evidence: Level III; Systematic Review.

Keywords: Bankart; Latarjet; anterior shoulder instability; arthroscopy; remplissage; systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Arthroscopy
Bankart Lesions*
Humans
Joint Instability* / surgery
Recurrence
Shoulder
Shoulder Dislocation* / surgery
Shoulder Joint* / surgery