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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 21 août 2018
Doi : 10.1016/j.otsr.2018.05.011
Received : 19 December 2017 ;  accepted : 22 May 2018
Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: A meta-analysis
 

Dimitri Camus a, , Peter Domos b, Emilie Berard c, Julien Toulemonde b, Pierre Mansat b, Nicolas Bonnevialle b
a Laveran Militarian Hospital, 13, boulevard Laveran, 13013 Marseille, France 
b Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Purpan, place du Dr Baylac, 31059 Toulouse, France 
c UMR1027 Inserm, Department of Epidemiology, Health Economics and Public Health, Toulouse University, Toulouse University Hospital (CHU), 31059 Toulouse, France 

Corresponding author.
Abstract
Introduction

Arthroscopic “remplissage” of a Hill-Sachs lesion (HSL) associated with a Bankart repair (BR) has been recently introduced as a surgical option to treat chronic anterior shoulder instability. The purpose of this study was to analyze the current literature comparing results of isolated BR versus BR+remplissage in the treatment of anterior shoulder instability with engaging HSL.

Hypothesis

BR+remplissage are superior to isolated BR in the management of anterior shoulder instability with engaging HSL.

Material and methods

Four electronic databases were searched for original, English-language studies comparing BR vs. BR+remplissage procedures. During the inclusion process we used international Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Our data were extracted from the text, tables and figures of the selected studies.

Results

Three comparative studies were identified, which included 146 patients; 74 of them underwent isolated BR, and 72 BR+remplissage procedure. The isolated BR results in significantly higher risk of recurrence and redislocation. There was no significant difference in the rates of reoperation and time to return to sport between the two procedures. Rowe and UCLA scores were lower in the isolated BR group compared with the BR+remplissage group.

Discussion

This meta-analysis demonstrates the superiority of BR+remplissage procedure vs. isolated BR in the management of anterior shoulder instability with engaging HSL and with up to 25% glenoid bone loss regarding redislocation rate, recurrent instability and functional scores. A comparison between postoperative range of motion and particularly external rotation was not able to be formally assessed in this study.

Level of evidence

III.

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Keywords : Bankart, Hill-Sachs “remplissage”, Meta-analysis, Shoulder instability




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