Comparison of arthroscopic osteochondral substitute grafting and remplissage for engaging Hill-Sachs lesions

The optimum management for recurrent glenohumeral instability with significant humeral head defects remains controversial. The purpose of this study was to compare outcomes and recurrence rates between patients who underwent osteochondral substitute grafting and patients who underwent remplissage to treat recurrent shoulder instability from an engaging Hill-Sachs defect with a Bankart lesion. Twenty consecutive patients who underwent remplissage and 19 consecutive patients who underwent osteochondral substitute grafting with Bankart repair were studied. Mean follow-up was 29.6 months for the remplissage group and 32.1 months for the osteochondral substitute grafting group. All patients had an engaging Hill-Sachs lesion, and indications for surgery were identical between groups. Three postoperative recurrences occurred in the remplissage group and 6 occurred in the osteochondral substitute grafting group (P=.18). Nineteen patients in the remplissage group and 7 patients in the osteochondral substitute grafting group had a large humeral head defect. Patients in the remplissage group had better Western Ontario Shoulder Instability Index [WOSI] scores than those in the osteochondral substitute grafting group for large lesions (74.7 vs 50.4, respectively), although they were not statistically significant (P=.077). After controlling for age, sex, lesion size, and follow-up differences, the remplissage group reported significantly better WOSI scores (P=.016). This study demonstrated a potential advantage of remplissage compared with osteochondral synthetic grafting in patients who experienced recurrent anterior shoulder instability, particularly in shoulders with a large humeral head defect.