Arthroscopic remplissage is safe and effective: clinical and magnetic resonance results at a minimum 3 years of follow-up

Abstract

Background: Large Hill–Sachs lesions are considered a risk factor for recurrence of instability after arthroscopic Bankart repair alone. The aim of this study was to demonstrate that remplissage is a safe procedure that effectively reduces the risk of recurrent dislocations without causing fatty degeneration of the infraspinatus at medium-term follow-up. Methods: Patients who underwent arthroscopic Bankart repair and remplissage with a minimum 3 years of follow-up were included. Constant–Murley (CMS), American Shoulder and Elbow Surgeons (ASES), and Walch–Duplay scores were evaluated. Magnetic resonance imaging (MRI) was performed to detect the appearance of fatty infiltration inside the infraspinatus muscle, the percentage of the Hill–Sachs lesion filled by the tendon and its integration, and the onset of rotator cuff tears. Results: Thirteen patients (14 shoulders) with a mean follow-up of 55.93 (± 18.16) months were enrolled. The Walch–Duplay score was 95.00 [87.25–100.00], with a return to sport rate of 100%. Both the CMS and the ASES indicated excellent results. The affected shoulders showed a statistically significant reduction in active external rotation both with the arm at the side (ER1) and with the arm at 90° of abduction (ER2) (p = 0.0005 and p = 0.0010, respectively). A reduction in infraspinatus isometric strength was found for both ER1 and ER2, but this reduction was only statistically relevant in ER2 (p = 0.0342). There was a traumatic recurrence of instability in two cases (14.28%). MRI evaluation demonstrated an absence of adipose infiltration in 50% of cases and only a minimal amount in the remaining 50%. In 12 cases (85.72%), the capsulotenodesis completely filled the lesion and good tendon–bone integration was observed. Conclusion: Arthroscopic remplissage provided successful clinical outcomes without fatty infiltration of the infraspinatus and with good healing of the tissues. The low risk of recurrence was associated with an objective limitation on active external rotation, but this did not influence the patients' daily or sports activities. Level of evidence: Cohort study, level of evidence 3.