A Prospective, Comparative, Radiological, and Clinical Study of the Influence of the "Remplissage" Procedure on Shoulder Range of Motion After Stabilization by Arthroscopic Bankart Repair

作者：Nourissat Geoffroy^*; Kilinc Alexandre Sahin; Werther Jean Roger; Doursounian Levon

来源：The American Journal of Sports Medicine, 2011, 39(10): 2147-2152.

DOI：10.1177/0363546511416315

• shoulder instability
• Bankart failure
• remplissage
• range of motion
• clinical outcomes
• prospective comparative study
• Hill-Sachs lesion
• Malgaigne

Background: Certain failures of arthroscopic Bankart repairs seem to be related to the presence of a Hill-Sachs defect. It has been suggested that Hill-Sachs lesions can be treated by "remplissage" (filling in) of the defect. The effect of this procedure on the mobility of the shoulder is not known.
Purpose: To determine if filling in the Hill-Sachs defect with rotator cuff tendon would modify the range of motion of the operated shoulder.
Study Design: Cohort study; Level of evidence, 2.
Methods: A prospective study of 2 patient populations (arthroscopic Bankart repair alone vs Bankart and remplissage) was undertaken after selecting patients using the Instability Severity Index Score (ISIS). Patients with a Hill-Sachs lesion seen on anteroposterior radiographs had a remplissage procedure if this procedure allowed them to obtain an ISIS lower than 4. The main clinical outcome was the range of motion (external rotation at the side [ER1], external rotation in abduction [ER2], internal rotation [IR], and forward elevation), assessed by the difference between each shoulder at 1 and 2 years' follow-up. Complications, recurrence, and the Walch-Duplay scores were noted at the same time. Minimum follow-up was 2 years.
Results: No significant statistical difference was noted in the range of motion between each group: ER1, difference of 4 degrees (P = .22); ER2, difference of 3 degrees (P = .49); anterior elevation, difference of 5 degrees (P = .35); and internal rotation, 2 vertebrae (P = .22). The rate of recurrence was identical in both groups (6.25%). For patients without redislocation, the Walch-Duplay score was excellent (14/17) or good (3/17) in the first group and excellent (12/15) or good (3/15) in the second group. Posterosuperior pain during forceful movements or when tired was noted in one third of patients having undergone remplissage.
Conclusion: The remplissage technique did not alter the range of motion of the shoulder compared with Bankart procedure alone; however, one third of patients did experience posterosuperior pain.

• 出版日期2011-10