Arthroscopic Bankart Repair With Remplissage Results in Low Recurrent Instability Rates Without Reducing Shoulder Range of Motion at Midterm Follow-up: A Systematic Review of Studies With Minimum 5-Year Outcomes

Background: Anterior shoulder instability remains a frequent occurrence in the young, active patient. Arthroscopic remplissage in addition to anteroinferior labral (Bankart) repair is a common treatment to address subcritical bone loss and decrease recurrent dislocation. Despite increasing use, concerns remain about the long-term outcomes of remplissage given its nonanatomic nature and relative novelty. Purpose: To systematically review published literature to assess functional outcomes, range of motion, recurrence rates, and subsequent revision rates after arthroscopic Bankart repair with remplissage for treatment of anterior shoulder instability with minimum 5-year follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the Scopus, PubMed, and Cochrane Library databases. Clinical studies reporting functional outcomes and recurrence data at a minimum of 5 years after arthroscopic Bankart repair and remplissage for shoulder instability were included for analysis. Results: Three studies including 144 shoulders met the inclusion criteria. The mean clinical follow-up was 104 months (9 years), with all patients having a minimum 60 months (5 years) of follow-up. Of the included patients, 77% were male and the mean age was 29 years (range, 15-72 years), with 51% participating in contact sports. All patients had glenoid bone loss <25%. The mean Rowe score increased from 49 to 97 (P < .001). No difference was found in preoperative versus postoperative forward elevation (171° vs 176°; P = .09) or external rotation at 90° of abduction (90° vs 86°; P = .09). The overall rate of recurrent instability events was 10%, with 8% of patients having a repeat dislocation, 4% undergoing repeat operation, and 76% returning to sport. Conclusion: In patients who had recurrent instability with an engaging Hill-Sachs lesion and subcritical glenoid bone loss, arthroscopic Bankart repair with remplissage showed excellent functional outcomes without restricting range of motion in published literature with minimum 5-year follow-up. The recurrent instability and dislocation rates remain lower than the reported rates after isolated Bankart repair. Further reports are needed to determine the clinical outcomes at long-term follow-up.