Arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in professional collision athletes

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Abstract
The present study aimed to determine whether arthroscopic remplissage with Bankart repair is an effective treatment for improving outcomes for collision athletes with Bankart and non-engaging Hill-Sachs lesions. Twenty collision athletes underwent arthroscopic Bankart repair with posterior capsulotenodesis (B&R group) and were evaluated retrospectively, using pre- and postoperative WOSI (Western Ontario Shoulder Instability), EQ-5D (EuroQOL five dimensions), EQ-VAS (EuroQol-visual analogue scale) scores and Subjective Shoulder Value (SSV). The recurrence and re-operation rates were compared to a matched group with isolated arthroscopic Bankart repair (B group). The mean age was 25 years with an mean follow-up of 26 months. All mean scores improved with SSV of 90%. There was a mean deficit in external rotation at the side of 10°. One patient was treated with hydrodilatation for frozen shoulder. One patient had residual posterior discomfort but no apprehension in the B&R group compared to 5% persistent apprehension in the B group. In comparison, the recurrence and re-operation rates were 5% and 30% (p = 0.015), 5% and 35% (p = 0.005) in the B&R and B groups, respectively. This combined technique demonstrated good outcomes, with lower recurrence rates in high-risk collision athletes. The slight restriction in external rotation does not significantly affect any clinical outcomes and return to play.

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