Michael P McCabe1, Douglas Weinberg2, Larry D Field3, Michael J O'Brien2, E Rhett Hobgood3, Felix H Savoie4. 1. Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A. 2. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A. 3. Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A. 4. Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A. Electronic address: fsavoie@tulane.edu.
Abstract
PURPOSE: This study aims to evaluate our outcomes of arthroscopic remplissage in this setting. METHODS: A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score. RESULTS: Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001). CONCLUSIONS: In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
PURPOSE: This study aims to evaluate our outcomes of arthroscopic remplissage in this setting. METHODS: A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score. RESULTS: Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001). CONCLUSIONS: In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instabilitypatients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Authors: Brian C Lau; Tyler R Johnston; Bonnie P Gregory; Lorena Bejarano Pineda; Mark Wu; Amanda N Fletcher; Jessica H Hu; Leila Ledbetter; Jonathan C Riboh Journal: Orthop J Sports Med Date: 2020-05-29
Authors: Hassanin Alkaduhimi; James W Connelly; Derek F P van Deurzen; Denise Eygendaal; Michel P J van den Bekerom Journal: Arthrosc Sports Med Rehabil Date: 2021-04-06