Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability

Nicolas Bonnevialle (1, 2) , Vadim Azoulay (1) , Amélie Faraud (1) , Fanny Elia (1) , Pascal Swider (2) , Pierre Mansat (1)

1 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
2 IMFT - Institut de mécanique des fluides de Toulouse

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.

Mots clés: Bankart; Failure; Hill-Sachs; Instability; Prognosis; Remplissage; Shoulder

Domaines: Mécanique des fluides [physics.class-ph]

Nicolas Bonnevialle, Vadim Azoulay, Amélie Faraud, Fanny Elia, Pascal Swider, et al.. Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability. International Orthopaedics, 2017, 41 (12), pp.2573-2580. ⟨10.1007/s00264-017-3491-5⟩. ⟨hal-02143189⟩