Adding remplissage to Bankart repair improves shoulder stability, but medial or two remplissage anchors decrease range of motion, according to new research.
Remplissage Improves Bankart Repair Results
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The study, “Bankart repair with remplissage restores better shoulder stability than Bankart repair alone, and medial or two remplissage anchors increase stability but decrease range of motion: a finite element analysis,” was published online on July 07, 2022 in the journal Arthroscopy.
The researchers wanted to better understand the effect of the number and location for remplissage on postoperative glenohumeral biomechanics. To do that, they used a finite element model constructed based on data from the intact glenohumeral joint. Then they created other models including a model of Bankart lesion combined with “off-track” Hill-Sach lesion, a model of Bankart repair alone, and four models of Bankart repair with remplissage based on different remplissage anchor numbers and positions.
Using the models, they studied the effects of the number and location of the remplissage anchors on glenohumeral stability. They particularly looked at the stress and its distribution on the joint capsule, cartilage, labrum, and anchors and the displacement of the humeral head.
Their analysis showed that contact stress on the glenohumeral cartilage decreased when medial or two anchors used, and also in the combined repair model with two medial anchors.
The stress on remplissage anchors, however, was greater when the anchors were placed medially. The humeral head displacement was largest in the combined lesion model. The researchers also found that the combined repair models with two medially placed anchors had the largest slope on the force-displacement curve. This they wrote, indicated the largest strain on the humeral head.
“Based on a finite element analysis, Bankart repair with remplissage restored better shoulder stability compared to Bankart repair alone in the treatment of anterior shoulder instability involving Bankart lesion combined with ‘off-track’ Hill-Sachs lesion. When the anchor for remplissage was medially placed or two anchors were used, the stability of the glenohumeral joint increased but with a loss of range of motion,” they wrote.
The study authors included Sija Feng, M.D., Huizhu Li, M.D., Yuzhou Chen, M.D., Jun Chen, Ph.D., Xiaoxi Ji, M.D., Ph.D., and Shivi Chen, M.D., Ph.D., all of the Sports Medicine Institute of Fudan University in Shanghai, China.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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