Background: The treatment algorithm for anterior shoulder instability continues to evolve. While a Bankart repair is most commonly performed arthroscopically, open Bankart repair procedures have shown good functional outcomes and have been reported to have a lower failure rate than arthroscopic techniques. Open Bankart repair procedures are often utilized in patients considered to be high-risk such as those with instability recurrence, subcritical glenoid bone loss, a Hill-Sachs lesion, high level contact athlete, or a previous failed repair. In similar high-risk cases, arthroscopic bankart repair (ABR) may be augmented with a remplissage procedure, which also addresses concomitant Hill-Sachs lesions. Both open Bankart repair and ABR with remplissage are useful techniques in this population, but few studies have directly compared their outcomes. Objectives: In this multicenter retrospective study, we aim to evaluate postoperative outcomes in patients undergoing either open Bankart repair or ABR with remplissage and to compare the results between the surgical approaches. Methods: A retrospective review of patients undergoing arthroscopic or open bankart repair procedures from 2011 to 2024 was performed at three separate healthcare centers. Patients were identified using either local institutional procedure codes for arthroscopic and open bankart repair, or current procedural terminology (CPT) codes 29805 and 23455, respectively. Patients were included if they underwent either ABR with remplissage or isolated open Bankart repair. Patients were excluded if they received an isolated ABR, an open bankart repair and remplissage during the same surgery, if they had a prior surgery on the ipsilateral shoulder for an indication other than instability, or if they had concomitant osteoarthritis, rheumatoid arthritis, or rotator cuff tears, and less than six months. Patient information was collected including age, sex, and body mass index (BMI), injury characteristics, prior shoulder surgeries, sport, hand dominance, and history of instability. Preoperative imaging was reviewed for presence of bony bankart lesions, hill sachs lesions, anterior or posterior labral tears, glenoid bone loss, or any other pathological findings. Primary outcomes were active range of motion, presence of recurrent instability, and revision surgeries. Other complications were noted including stiffness, infection, nerve injury, persistent pain, and development of osteoarthritis. Results: A total of 82 patients were included, 21 females (25.6%) and 61 males (74.4%). Mean age was 24.1 ± 9.3 years and mean follow-up was 14.0 ± 11.0 months. There were 19 patients in the ABR with remplissage group and 63 patients in the open bankart repair group. Groups were similar in age, BMI, and sex composition. The ABR with remplissage group had shorter follow-up than the open Bankart group (8.2 ± 3.8 vs. 15.8 ± 11.9 months, P = .002). Patients in the ABR with remplissage group were more likely to have a history of shoulder instability (94.7% vs. 69.3%, P = 0.032), and more likely to have a Hill-Sachs lesion (100% vs. 79.0%, P = 0.032). There were no differences in the prevalence of glenoid bone loss within each cohort (P = 0.776). The open Bankart group had reduced postoperative internal rotation compared to the ABR with remplissage group that approached statistical significance (P = 0.055). There were no significant differences between groups in postoperative range of motion in forward flexion, abduction, external rotation, or internal rotation. Ten patients overall (12.3%) had recurrent instability postoperatively. There were no significant differences in the incidence of recurrent instability (P = 0.692) or revision surgery (P = 1.00) between groups. Conclusions: The results of this study found no difference in postoperative range of motion, instability recurrence, or subsequent revision surgery between patients who underwent arthroscopic Bankart repair with remplissage or open Bankart repair. Overall, instability recurrence was low, indicating both are safe and effective techniques for treating anterior shoulder instability. The comparative findings should be interpreted carefully due to study limitations. Notably, the treatment groups differed in the prevalence of Hill-Sachs lesions, indicating bias in surgical decision-making influenced by baseline pathology which may confound comparisons. Nonetheless, with recent advancements in arthroscopy improving upon th efficiency of remplissage techniques, arthroscopic bankart repair with remplissage represents a suitable, less invasive alternative to open Bankart repair in high-risk patients with anterior shoulder instability.
Adan et al. (Fri,) studied this question.