Visualizing the Effect of Arthroscopic Bankart Repair and Remplissage: A Pre- and Postoperative Ultrasonographic...

Arthroscopic Bankart repair and the remplissage procedure are minimally invasive treatments for anterior shoulder instability. Cadaveric studies have demonstrated the biomechanical effectiveness of these treatments, and clinical studies have reported favorable outcomes; however, quantitative clinical data are required to confirm their in vivo biomechanical efficacy.

Bankart repair and remplissage, based on previous preclinical studies, could significantly reduce anterior humeral head translation (AHHT) in clinical patients.

Cross-sectional study; Level of evidence, 3.

A total of 29 patients (23 male, 6 female; mean age, 21.7 ± 7.1 years), diagnosed with anterior shoulder instability, were studied between March 2020 and September 2023. Of these patients, 11 underwent only arthroscopic Bankart repair, whereas the remaining 18 underwent remplissage combined with arthroscopic Bankart repair. All procedures were performed under general anesthesia in the beach-chair position. Ultrasonographic evaluations were conducted by the same surgeon immediately pre- and postoperatively. In each shoulder abduction position at 0°, 45°, and 90°, the posterior aspect of the glenohumeral joint was visualized using ultrasonography before and after applying a 40-N anterior force to the upper arm using a handheld dynamometer. AHHT was quantified by measuring the change in distance from the posterior edge of the glenoid to the humeral head due to the traction force at each shoulder angle.

Postoperative assessments revealed a significant reduction in AHHT at 90° (from 8.8 ± 5.3 mm to 6.1 ± 2.8 mm; P = .02) of abduction. Subgroup analysis showed that this reduction was significant only when Bankart repair was combined with remplissage (from 10.1 ± 6.0 mm to 5.9 ± 2.9 mm; P = .01). Posterior shifts of the humeral head without traction were observed at 0° (2.7 ± 3.2 mm; P < .001), 45° (2.4 ± 2.7 mm; P < .001), and 90° (3.6 ± 2.5 mm; P < .001) of abduction. Subgroup analysis showed these shifts were significant for all abduction angles except 0° in the group that underwent Bankart repair with remplissage (for Bankart repair alone: [0°] 4.4 ± 3.3 mm, P = .005; [45°] 3.0 ± 3.2 mm, P = .04; and [90°] 4.6 ± 2.1 mm; P < .001; for Bankart repair with remplissage: [0°] 1.6 ± 2.6 mm, P = .06; [45°] 2.1 ± 2.3 mm, P = .006; and [90°] 3.0 ± 2.5 mm, P < .001).

Arthroscopic Bankart repair combined with remplissage significantly reduced AHHT at 90° of abduction, whereas Bankart repair alone showed no significant decrease in AHHT at any abduction angle. However, both Bankart repair alone and Bankart repair with remplissage caused a posterior shift of the humeral head without load at 0°, 45°, and 90° of abduction. Measuring AHHT could be critical for assessing postoperative anterior shoulder instability, as it provides the surgeon with objective data to evaluate the procedure's success and guide postoperative management. Future research could investigate clinical differences based on the measured AHHT, potentially providing valuable insights for improving patient outcomes.