Nicolas Bonnevialle1,2, Vadim Azoulay3, Amélie Faraud3, Fanny Elia3, Pascal Swider4, Pierre Mansat3. 1. Département d'Orthopédie Traumatologie du CHU de Toulouse, Hôpital Riquet, Place Baylac, 31052, Toulouse, France. nicolasbonnevialle@yahoo.fr. 2. Laboratoire de Biomécanique, IMFT-UMR-CNRS 5502, Hôpital Riquet, Place Baylac, 31052, Toulouse, France. nicolasbonnevialle@yahoo.fr. 3. Département d'Orthopédie Traumatologie du CHU de Toulouse, Hôpital Riquet, Place Baylac, 31052, Toulouse, France. 4. Laboratoire de Biomécanique, IMFT-UMR-CNRS 5502, Hôpital Riquet, Place Baylac, 31052, Toulouse, France.
Abstract
PURPOSE: The aim of this study was to evaluate mid-term outcomes of Bankart repair with Hill-Sachs remplissage (BHSR) and to highlight prognostic factors of failure. METHODS: Thirty-four patients operated on for anterior shoulder instability with BHSR were enrolled in a prospective non-randomised study. Clinical and radiographic evaluation was performed at 1.5, three, six months and yearly thereafter. Outcome measures included Rowe and Walch-Duplay score. RESULTS: At mean follow-up of 35 months (24-63), the Rowe and Walch-Duplay scores reached respectively 92.7 and 88.2 points. The mean deficit in external rotation was 6° in ER1 and 1° in ER2 (p = 0.4, p = 0.9 respectively). Five patients (14.7%) had a recurrence of instability and three others had a persistent anterior apprehension. In the failure group, the Hill-Sachs lesion was deeper (26% vs 19% of the humeral diameter; p = 0.04) and range of motion at 1.5 months postoperatively was greater. Age at surgery, pre-operative instability severity index score (ISIS), hyperlaxity, type and level of sport, amount of glenoid bone loss had no correlation with failure rate. CONCLUSIONS: The rate of failure at mid-term follow-up of BHSR was higher than commonly reported. The premature recovery of range of motion seems to be a clinical sign of failure at follow-up. Moreover, in case of deep Hill-Sachs lesion (>20%) an alternative procedure should be considered. LEVEL OF EVIDENCE: Level IV.
PURPOSE: The aim of this study was to evaluate mid-term outcomes of Bankart repair with Hill-Sachs remplissage (BHSR) and to highlight prognostic factors of failure. METHODS: Thirty-four patients operated on for anterior shoulder instability with BHSR were enrolled in a prospective non-randomised study. Clinical and radiographic evaluation was performed at 1.5, three, six months and yearly thereafter. Outcome measures included Rowe and Walch-Duplay score. RESULTS: At mean follow-up of 35 months (24-63), the Rowe and Walch-Duplay scores reached respectively 92.7 and 88.2 points. The mean deficit in external rotation was 6° in ER1 and 1° in ER2 (p = 0.4, p = 0.9 respectively). Five patients (14.7%) had a recurrence of instability and three others had a persistent anterior apprehension. In the failure group, the Hill-Sachs lesion was deeper (26% vs 19% of the humeral diameter; p = 0.04) and range of motion at 1.5 months postoperatively was greater. Age at surgery, pre-operative instability severity index score (ISIS), hyperlaxity, type and level of sport, amount of glenoid bone loss had no correlation with failure rate. CONCLUSIONS: The rate of failure at mid-term follow-up of BHSR was higher than commonly reported. The premature recovery of range of motion seems to be a clinical sign of failure at follow-up. Moreover, in case of deep Hill-Sachs lesion (>20%) an alternative procedure should be considered. LEVEL OF EVIDENCE: Level IV.
Authors: Miguel Angel Ruiz Ibán; Cristina Victoria Asenjo Gismero; Santos Moros Marco; Raquel Ruiz Díaz; Teresa Del Olmo Hernández; Gabriel Del Monte Bello; Miguel García Navlet; Jose Luis Ávila Lafuente; Jorge Díaz Heredia Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-06 Impact factor: 4.342