Effectiveness of Arthroscopic Bankart Repair and Remplissage in Treating Shoulder Instability with Hill-Sachs Lesions

Introduction: Glenohumeral joint instability is one of the commonest disorders of the shoulder as it has a great range of motion on the expense of stability as referred to the bony configuration of the joint. Instability may be traumatic or atraumatic and uni-directional or multi-directional with wide range of patient complaints from mild pain in micro-instability to obvious dislocation.The most commonly used arthroscopic procedure include filling the humeral head defect by capsulo-tenodesis of the infraspinatus tendon and posterior capsule (Remplissage). Aim: To present our results of Bankart repair and Reimplissage in management of recurrent shoulder instability with Hill-Sachs lesions. Method: 20 young, middle age and fit patients with recurrent anterior shoulder dislocation with combined Bankart lesion and Hill-Sachs lesion. All Hill-Sachs lesions were large or engaging (Calandra grade 3 at time of arthroscopy) and all were managed by arthroscopic Bankart repair combined with Remplissage. Results: When compared to pre-operative ROM, a statistically significant difference was found in the mean increase of anterior elevation by 2?, external rotation (ER) side by 4? and 5? for ER at 90? abduction at final follow-up (p value < 0.001). There were statistically significant difference in the mean decrease of 5? and 10? in ER side and ER at 90? abduction respectively at final follow-up compared to normal side ROM (p value < 0.001), also significant decrease in anterior elevation by 4? and IR at 90? abduction by 2? (p value < 0.001) which were not comparable to other studies but was clinically insignificant. The mean final Rowe and SST scores were 85 and 11.35 respectively indicating a statistically significant difference in mean increase of both the total Rowe and total SST percentage score when compared to pre-operative scores (p value < 0.001). All patients were followed prospectively for a minimum of 12 months. Conclusion: Arthroscopic Bankart repair and remplissage is an effective means of managing shoulder instability in patients with large Hill-Sachs lesions and no significant glenoid bony defect.