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Arthroscopic "Remplissage" for shoulder instability: a systematic review
Mustafa S Rashid1, James Crichton1, Usman Butt1
1Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Summary
Arthroscopic remplissage effectively treats recurrent shoulder instability by addressing large Hill-Sachs lesions. This technique shows low redislocation and instability rates, though further high-quality trials are needed for comparison.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Large Hill-Sachs lesions engaging the glenoid rim are associated with recurrent anterior shoulder instability.
- These lesions often lead to the failure of isolated labrum repairs.
- Arthroscopic remplissage involves suturing posterior capsule and infraspinatus into the humeral defect to mitigate engagement.
Purpose of the Study:
- To systematically review the outcomes and complications of arthroscopic remplissage for managing anterior shoulder instability.
- To assess the efficacy of arthroscopic remplissage in cases with engaging Hill-Sachs lesions.
Main Methods:
- A systematic literature search was performed across MEDLINE, EMBASE, and Cochrane databases.
- Data from eight studies, totaling 207 patients, were extracted by two independent reviewers.
- Rates of redislocation, recurrent instability, and complications were calculated with 95% confidence intervals.
Main Results:
- The mean redislocation rate was 4.2% (95% CI, 0-15%) and recurrent instability rate was 3.2% (95% CI, 0-15%).
- Posterosuperior shoulder pain and stiffness were the primary complications reported.
- A mean reduction in external rotation in adduction (5.6°), abduction (11.3°), and internal rotation (0.9°) was observed.
Conclusions:
- Arthroscopic remplissage, when combined with anterior labrum repair, appears successful for treating recurrent shoulder instability with large or engaging Hill-Sachs lesions.
- The current evidence is largely based on heterogeneous case series.
- High-quality randomized controlled trials are necessary to compare arthroscopic remplissage with alternative procedures like the Latarjet procedure for substantial Hill-Sachs defects.
