Results of anterior shoulder instability treatment with anterior labroligamentous periosteal sleeve avulsion lesion comparing arthroscopic Bankart repair with or without remplissage.

Abstract

The complexity of the anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion is linked to an increased frequency of shoulder dislocations and a higher failure rate after surgical treatment. The purpose of this study was to determine whether arthroscopic treatment combining Bankart repair with a remplissage procedure reduces recurrence rates and improves functional outcomes compared to isolated Bankart repair. A retrospective cohort study was conducted on patients treated between 2009 and 2014 at our hospital for traumatic anterior shoulder instability with ALPSA lesions and subcritical bone loss. Epidemiological data, recurrence of instability, range of motion, and functional outcomes were evaluated using Rowe, Walch-Duplay, and Western Ontario Shoulder Instability Index scales. A total of 65 patients were included in the study (30 treated with isolated Bankart repair and 35 with a combination of Bankart and remplissage technique). At a minimum 5-year follow-up period, there were no statistically significant differences in recurrence rates between the group treated with the combined technique (5.7%) and those treated with Bankart repair alone (16.7%) (P = .234). Patients treated with the combination of both procedures had better results on functional evaluation scales: Rowe (89.2 vs. 74.5; P = .009), Walch-Duplay (90 vs. 81.5; P = .016), and Western Ontario Shoulder Instability Index (89.8% vs. 76.3%; P = .007). Arthroscopic Bankart repair with remplissage augmentation did not result in a statistically significant difference in recurrence rates for the treatment of ALPSA lesions with subcritical bone defects. Additionally, remplissage significantly improved functional outcomes compared to isolated Bankart repair.