Arthroscopic Bankart repair with or without remplissage: a single-institution cost comparison

Remplissage is a useful adjunct to repair of the anteroinferior glenoid labrum in the treatment of anterior shoulder instability. This study aimed to compare costs and clinical outcomes between isolated arthroscopic Bankart repair (ABR) and ABR with remplissage.

This was a retrospective study of all patients who underwent arthroscopic treatment of anterior shoulder instability between June 2011 and August 2021. Patient, procedural factors, and clinical outcome data were collected. Financial data was reported as "relative costs". The best fit circle method was utilized on MRI to estimate glenoid bone loss (GBL) and the Hill Sachs Interval (HSI). Using the glenoid track, patients were determined to either have 'on' or 'off' track lesion.

48 patients who underwent ABR alone and 49 patients who underwent ABR with remplissage were matched and included in analysis. There was no significant difference in total cost, mean number of dislocations, ED visits, or revision surgery between isolated ABR and ABR with remplissage. The remplissage cohort had a significantly higher rate of "off-track" lesions (24.5% vs. 6.2%, p = 0.013), % GBL (8.7% vs. 5.7%, p = 0.015) and Hill Sachs lesion size (16.7 ± 4.1 mm vs. 8.9 ± 6.9 mm, p < 0.001).

No differences in total cost were found between ABR with or without addition of remplissage. Clinical outcomes were similar in both groups, despite a significant increase in the number of off-track lesions, HSI and GBL seen in the remplissage group. Surgeons may consider addition of remplissage in the appropriate clinical context with low concern of increased cost.

Level 3.