While most athletes are able to return to the same level of sport after Bankart repair with remplissage, certain groups like throwing athletes have a slightly lower return rate, according to a new study.
Return to Sport After Bankart Repair With Remplissage
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“Return to Sport after Arthroscopic Bankart Repair with Remplissage: A Systematic Review,” was published online on January 12, 2023 in the journal Arthroscopy.
A multi-center research team from McMaster University (Hamilton, Ontario), University of Limerick (Limerick, Ireland) and Western University (London, Ontario) designed a study to determine what differences, if any, exist regarding return to sport after arthroscopic Bankart repair with remplissage.
The team collected data from EMBASE, PubMed and MEDLINE databases regarding overall rate of return to sport, rate of return to pre-injury level of sport, and the rate of return for specific subgroups such as contact or throwing athletes. They also recorded return to sport and functional outcomes.
The team included 20 studies with data from 736 patients and 738 shoulders. The mean age was 28 years. The majority of patients were male and the mean follow-up time after surgery was 45 months.
Overall, the researchers found that rate of return to any level of sport ranged from 60-100%, while the rate of return to the pre-injury level ranged from 63% to 100%. When patients who underwent the Bankart repair with remplissage as a revision procedure were excluded, the rate of return to any level of sport was 68-100%.
The return to sport rates for contact or collision athletes ranged from 80 to 100% and for overhead or throwing athletes was 46 to 79%. They also estimated the rate of recurrence of instability postoperatively to be 0-20%.
“For athletes with anterior shoulder instability, arthroscopic Bankart repair with remplissage led to a high rate of return to sport along with a low rate or recurrence of instability,” they wrote.
Study authors include Kyle Gouveia, M.D., of McMaster University, Hamilton, Ontario, Canada, Eric Harbour, BSc., of University of Limerick, Limerick, Ireland, George S. Athwal, M.D., FRCSC of Hand and Upper Limb Centre, Western University, London, Ontario, Canada and Moin Khan, M.D., MSc., FRCSC of St. Joseph’s Hospital Hamilton, Hamilton, Ontario, Canada.
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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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