Previously, we conducted a multi-center, double-blinded randomized controlled trial comparing arthroscopic Bankart repair with and without remplissage. The end point for the randomized controlled trial was two years post-operative, providing support for the benefits of remplissage in the short term in reducing recurrent instability. The aim of this study was to compare the medium term (3 to 9 years) outcomes of patients previously randomized to have undergone isolated Bankart repair (NO REMP) or Bankart repair with remplissage (REMP) for the management of recurrent anterior glenohumeral instability. The rate of recurrent instability and instances of re-operation were examined. The original study was a double-blinded, randomized clinical trial with two 1:1 parallel groups with recruitment undertaken between 2011 and 2017. For this medium-term study, participants were reached for a telephone follow-up in 2020 and asked a series of standardized questions regarding ensuing instances of subluxation, dislocation or reoperation that had occurred on their shoulder for which they were randomized. Descriptive statistics were generated for all variables. “Failure” was defined as occurrence of a dislocation. “Recurrent instability” was defined as the participant reporting a dislocation or two or more occurences of subluxation greater than one year post-operative. All analyses were undertaken based on intention-to-treat whereby their data was analyzed based on the group to which they were originally allocated. One-hundred and eight participants were randomized of which 50 in the NO REMP group and 52 in the REMP group were included in the analyses in the original study. The mean number of months from surgery to final follow-up was 49.3 for the NO REMP group and 53.8 for the REMP group. The rates of re-dislocation or failure were 8% (4/52) in the REMP group at an average of 23.8 months post-operative versus 22% (11/50) in the NO REMP at an average of 16.5 months post-operative. The rates of recurrent instability were 10% (5/52) in the REMP group at an average of 24 months post-operative versus 30% (15/50) in the NO REMP group at an average of 19.5 months post-operative. Survival curves were significantly different favouring REMP in both scenarios. Arthroscopic Bankart repair combined with remplissage is an effective procedure in the treatment of patients with an engaging Hill-Sachs lesion and minimal glenoid bone loss (<15%). Patients can expect favourable rates of recurrent instability when compared with isolated Bankart repair at medium term follw-up

Aims. The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents. Methods. We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed. Results. A total of 51 adolescents were included, of whom 46 (92%) were male, with 17 (33%) in the Latarjet group and 34 (66%) in the Bankart group. The mean age at time of surgery was 18 years (15 to 19). There were no intraoperative complications. At a median follow-up of nine years (IQR 2 to 18), recurrence was observed in 12 patients in the Bankart group (35.3%) and one patient in the Latarjet group (5.9%) (p = 0.023). Satisfactory postoperative outcomes were obtained, with mean Rowe, WOSI, and SANE scores noted at 95 (10 to 100), 325 (25 to 1,975), and 87.5 (10 to 100), respectively. Most patients (29 in the Bankart group (85.3%) and 16 in the Latarjet group (94.1%)) were able to return to sport (p = 0.452). Conclusion. The ABR and AL procedures both obtain satisfactory clinical and functional outcomes in the treatment of anterior glenohumeral instability in adolescents with a low complication rate. However, the ABR is associated with a significantly higher recurrence rate. Cite this article: Bone Jt Open 2024;5(11):1041–1048

Introduction. The Bankart lesion is the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder. Various methods have been described each with its own advantages and disadvantages. We describe 5-year results of arthroscopic Bankart repair using knotless anchors. Patients and Methods. There were 38 patients, with involvement of the dominant arm in 28 patients. Recurrent dislocation was the most common indication in 21 patients, followed by first dislocation in 9 patients and second dislocation in 8 patients. All patients were done under general anesthesia and regional block in beach-chair position. Standard portals were used and repair done using 2.9 mm pushlock knotless anchors (Arthrex®). Patients had sling for 4 weeks and followed by a strict physiotherapy rehab protocol. Patients were followed up at 6 weeks and 3 monthly thereafter. Results. Only one patient had symptoms of recurrent instability, but was not keen on further surgery. Two patients had limitation of external rotation to 10 degrees. The mean Carter-Rowe score was 77.3. 90% of patients were happy to recommend surgery. Conclusion. Arthroscopic Bankart repair appears to produce good mid-term results for patients with shoulder instability

Purpose: Although arthroscopic Bankart repair is yet an established procedure in the treatment of traumatic anterior shoulder instability, it is still not known whether it reproduces the good results of the open repair procedure. Aim of this investigation was to compare the functional and subjective outcome between open and arthroscopic Bankart repair. Material and methods: A retrospective cross sectional study design on the comparison of open and arthoscopic Bankart treatments between 1995 and 2004 was implemented at the Dresden Orthopedic Surgery Department. In this period a total of 223 patients underwent surgery due to anterior shoulder instability, among which 212 patients had posttraumatic instability. A diagnostic arthroscopy was performed in all patients, but only 40 patients with intact capsulolabral complex and without capsular laxity were treated arthroscopically, the remaining 183 patients underwent an open Bankart procedure. A total of 186 patients with posttraumatic anterior instability could be clinically re-examined within 1 to 5 years after initial surgery, among which 147 patients underwent an open and 39 patients an arthroscopic Bankart procedure. The median age of this sample was 27 years (interquartile range 21 – 37 years) at initial surgery, 21% of these patients were female. Results: After open surgery 11 of 147 patients (8%) and 6 of 39 (15%) after arthroscopic surgery reported one or more re-dislocation after initial treatment, which occurred after a mean dislocation free time of 62 versus 40 months, respectively (95% confidence intervals 59 – 65 versus 36 – 44 months). Both a univariate analysis (Logrank test p=0.012) and a multivariate Cox regression analysis (Likelihood Ratio p=0.023) confirmed a statistically significant difference in the time between initial surgery to first reluxation. 4 of the 11 re-dislocations after open and 1 of 6 after arthroscopic surgery occurred after a new accident. That makes a re-dislocation rate without new adequate trauma of 5% after open and 13% after arthroscopic treatment. ROM showed no difference between open and arthroscopic Bankart procedure for abduction and a mild difference for external rotation. 21 of 115 (18%) patients had an external rotation lag of 20° or more after open surgery versus 1 of 34 (3%) after arthroscopic treatment (Fisher p=0,027). The Rowe score demonstrated “good” or “excellent” functional results in 102 of 117 (87%) patients versus 28 of 35 (80%) patients after open versus arthroscopic treatment (Fisher p=0,285). Conclusion: In this sample arthroscopic Bankart repair demonstrated more frequently and significantly earlier re-dislocation after initial surgery than did the open treatment alternative. External rotation lags of at least 20° occured more frequently after the open procedure

Background: There is a huge controversy regarding the period of immobilization after Bankart stabilisation. This ranges from 2 days to 5 weeks for open repair and from 3 to 6 weeks for arthroscopic Bankart repair. We believe it is inappropriate to immobilise the operated shoulder after Bankart repair. In our study all the patients were allowed to use their arm, the same day, pain permitting. No restrictions were imposed for the type and range of movement for those who had open repair. With arthroscopic repair they were asked to limit their shoulder abduction upto 45-degreee and external rotation to neutral. Method: In this retrospective study (1998–2003) we have analyzed the outcome of mobilisation of operated shoulder on the same day.43 primary stabilisations were performed by the senior author.one patient was uncontactble. We reviewed the records of 42 patients. Subsequently the General Practitioners were contacted to collect information about these patients and the patients were contacted, if needed. Out of 42 patients 34 were males and 8 females. 35 patients had an average of 7 episodes of anterior shoulder dislocations (range 2–25), 7 had unstable shoulder pre-operatively.30 had open repair, 12 had arthroscopic stabilisation. The average follow-up is 3.5years(1–6 years). Result: 41 patients did hot have any further episode of frank anterior shoulder dislocation and they had returned to their previous level of activities. Only one patient injured his operated shoulder year later while playing football. He underwent arthroscopic capsular shrinkage for traumatic deformation of the capsular and inferior glenohumeral ligament. Conclusion: In primary straightforward Bankart stabilisation, same day mobilisation does not increase the risk of anterior shoulder dislocation

Recurrence represents the leading complication of arthroscopic anterior shoulder stabilization. Even with modern suture anchor techniques, a recurrence rate of between 5 to 20% persists; emphasizing that arthroscopic Bankart repair cannot apply to all patients and selection must be done. Numerous prognostic factors have already been reported, but strict observance would eliminate almost all patients from arthroscopic Bankart repair. We hypothesised that clinical and radiological risk factors could be present and identifiable in the normal outpatient visit, and they could be integrated into a severity score. A case-control study was undertaken, comparing patients identified as failures after arthroscopic Bankart repair (i.e, recurrent instability) with those who had a successful result (i.e., no recurrence). Recurrence was defined as any new episode of dislocation or any subjective complains of subluxation. During a four-year period one hundred and thirty-one consecutive patients with recurrent anterior shoulder instability, with or without shoulder hyperlaxity, were operated by the senior shoulder surgeon with an arthroscopic suture anchor technique and followed for a minimum of two years. Patients were excluded if concomitant pathology, including multidirectional instability, were present. Bony lesions were not excluded. A complete pre and postoperative questionnaire, physical exam, and anteroposterior x-ray were recorded. Mean follow-up was 31.2 months (range, twenty-four to fifty-two months). Nineteen patients had a recurrent anterior instability (14.5%). Preoperative evaluation demonstrated that age below twenty years old, involvement in athletic competition, participation in contact or forced-overhead sports, presence of shoulder hyperlaxity, Hill-Sachs lesion visible on AP external X-ray, and loss of inferior glenoid sclerotic contour on AP x-ray were all factors related to increased recurrence. These factors were integrated in an Instability Severity Index Score and tested retrospectively on the same population. Patients with a score of six or less had a recurrence risk of 10% and those over six had a recurrence risk of 70% (p< 0.001). This study proved that a simple scoring system based on factors of a preoperative questionnaire, physical exam, and anteroposterior x-ray can help the surgeon to select patients who would benefit from arthroscopic stabilization with suture anchors and those for whom an open surgery, like the Latarjet procedure, is a better option

Purpose: Arthroscopic stabilization for post-traumatic anterior glenohumeral instability is designed to minimize soft tissue dissection while achieving similar or improved outcomes relative to open techniques. This study’s purpose was to determine the rate of post-operative recurrent instability and evaluate health related quality of life (HRQL) and shoulder range of motion (ROM) following arthroscopic Bankart repair using a bioabsorbable knotless implant. Method: Forty-three patients were prospectively evaluated following arthroscopic anterior stabilization to assess for recurrent instability, HRQL, and shoulder ROM. Assessments were performed pre-operatively and 3, 6 and 12–24 months postoperatively. The HRQL measures included the Western Ontario Shoulder Instability Index (WOSI), the American Shoulder and Elbow Surgeons Score (ASES), and the Constant Score. Repeated measures ANOVA was utilized to evaluate ROM and HRQL. Results: The mean WOSI score improved from 45.67±17.99 pre-operatively to 83.16±18.58 at final follow-up. The mean ASES scores improved from 80.1±13.06 pre-operatively to 92.25±15.08, while the Constant score improved from 77.52±16.11 pre-operatively to 85.18±26.76. At final follow-up, 4 of 43 patients (9.3%) had experienced recurrent instability. For these 4 subjects, the WOSI score was significantly lower at final follow-up than those who did not experience recurrent instability (61.73±5.76 versus 84.38±16.94). The ASES and Constant scores at final follow-up were not significantly different between these two groups. Conclusion: Arthroscopic anterior stabilization using a bioabsorable tack led to a recurrent instability rate similar to previous reports, and resulted in improved HRQL and shoulder ROM. The WOSI score was better able to detect problems in HRQL related to instability than either the ASES or Constant score

We have undertaken to review Bankart stabilisations performed by the senior author in Newcastle since 1998. We employ a modification of the technique as described by Rowe et al, but without a coracoid osteotomy and using suture anchors. Where there is also an element of inferior instability this was combined with a capsular shift at the same time. We performed a retrospective case note review of all patients in the study period, following this all patients were sent out a postal questionnaire based on the Oxford Instability Score (OIS). A total of 50 Bankart repairs were performed in the study period, no significant wound infections or haematomas were recorded. 3 patient had further dislocations and required revision surgery; a further 2 patients had ongoing symptoms of instability one of which has had revision. Response rate to the questionnaire was 62%. Mean OIS for patients following primary stabilisation was 21.7 (possible scores from 12 – excellent outcome to 60 – poor outcome). OIS following Bankart stabilisation of the shoulder has not been previously reported. These results compare favourably to original scores published by Carr et al (1999) who included both patients treated by surgery and physiotherapy alone. The OIS was shown to be very sensitive in detecting instability symptoms noted at clinical review. The response pattern of the scores closely mirrored that from Carr and co-workers

Little is known about how arthroscopic knots behave in terms of reverse slippage and creep during the first few hours following a Bankart repair. We aimed to assess differences between knot types tied with a variety of suture materials when exposed to loading which might be expected during the first 12 hours following a repair. This study uses an apparatus to model the tensioning of a slipknot, the closing of a Bankart lesion and any reverse slippage occurring on removal of the tensioning force. Eight examples each of the Duncan loop and SMC knots were tied by an experienced surgeon using 4 different suture materials (PDS, Ethibond, Panacryl, Fibrewire). An arthroscopic knotting technique was used utilising a knot pusher. Each knot was locked with 3 half-hitches alternating direction and post each time. Any reverse slippage occurring during the tying process was recorded. Each knot was then left in situ for 12 hours under loads equivalent to a repaired Bankart lesion and any subsequent reverse slippage was recorded at the end of this period. After initial passing of the Duncan loop the sutures were ranked inversely to size of suture loop (resistance to slippage) in order Panacryl (5.08±0.15mm); Fibrewire (5.7±1.03mm); Ethibond (7.22±3.47mm) and PDS (8.2±5.16mm). After passing of locking hitches, they ranked Ethibond (5.13±0.24mm); PDS (5.15±0.09mm); Panacryl (5.17±0.13mm) and Fibrewire (5.66±0.5mm – significant p< 0.05). After 12 hrs, some evidence of reverse slippage was noted, Ethibond (5.23±0.27mm); PDS (5.27±0.13mm); Panacryl (5.3±0.16mm) and Fibrewire (5.66±0.5mm – significant p< 0.05). The SMC knot showed similar results. If a slip-knot back slips it can be tightened with the first locking hitch. After this further hitches do not tighten the knot further. Some slippage was noted during the first 12 hrs. Using arthroscopic techniques, Fibrewire performs less well than other materials

To report the results of the vertical apical suture Bankart lesion repair. Fifty-nine patients (52 men and 7 women) with a mean age of twenty-seven years (range, 16 to 53 years) were studied. The mean duration of instability was 4. 1 years and mean follow-up was 42 months (range 24 to 58 months). A laterally based T-shape capsular incision was performed with the horizontal component directed towards the glenoid neck and into the Bankart lesion. A vertical apical suture through the superior and inferior flaps of the Bankart lesion, tightens the anterior structures to allow them to snug onto the convex decorticated surface of the anterior glenoid. The inferior flap of the capsule was then shifted superiorly and the superior flap shifted inferiorly to augment the anterior capsule, with the shoulder in 20 degrees of abduction and 30 degrees of external rotation. At final review, according to the system of Rowe et al., 94. 9% (56 patients) had a rating of good or excellent. Three patients had a recurrent dislocation due to further trauma. The mean loss of forward elevation was 1 degree, external rotation with the arm at the side was 2. 4 degrees and external rotation in 90 degrees abduction was 2. 2 degrees. Of forty-four patients participating in sport, thirty-five (79. 5%) returned to the same sport at the same level of activity, seven returned to the same sport at a reduced level of activity and two patients did not return to sport. The vertical apical suture repair offers a 94. 9% stability rate, a maintained range of motion and a 79. 5% return to pre-injury level of sporting activity. It is technically less demanding than the Bankart procedure. All sutures used are absorbable. Complications related to non-absorbable implants and absorbable anchors and tacks are avoided

Primary traumatic anterior dislocations of the shoulder are common injuries which are complicated by persistent instability in a high proportion of patients. Surgery is successful and has been well described in the literature. Current controversies centre on the role of open and arthroscopic techniques. We describe the outcomes of a new mini-incision surgical (MIS) technique which was developed within our institution.

27 patients with traumatic shoulder instability (2 bilateral) were prospectively entered into a database between June 1998 and March 2008. The mean age was 31 years and the mean follow up period was 53 months. 29 shoulders underwent diagnostic shoulder arthroscopy and mini-incision surgery using a delto-pectoral approach and 3 bio-absorbable anchors.

Patients reported no re-dislocation in 24 shoulders (83%). 5 shoulders, including one with a bony Bankart lesion, re-dislocated with additional trauma. One shoulder required revision to a Bristow-Latarjet. Satisfaction was very good in 16 and good in 9 shoulders (83%). 19 patients had minimal or no pain. 8 patients experienced moderate shoulder pain with the other two complaining of severe pain. QuickDASH scores were encouraging.

Our technique combines the ability to appreciate all shoulder pathology arthroscopically with the visualisation gained in open Bankart surgery. Functionally, patients do well. The higher than expected re-dislocation rate is concerning. We advise that long term outcomes are needed.

Coracoid fractures during screw insertion and graft osteolysis are serious concerns with standard screw fixation techniques in Latarjet procedure. This study tends to evaluate the outcome of mini open Latarjet using Arthrex mini-plate for coracoids graft fixation. We did retrospective analysis of 30 patients with recurrent anterior shoulder instability after arthroscopic Bankart's repair. A low profile wedge plate (Arthrex) with two low profile screws was used for fixation of the coracoid graft. CT analysis was performed at final follow up to see graft union and results were evaluated using American shoulder and elbow score (ASES) and Western Ontario shoulder instability score (WOSIS). Mean follow up time was 24 months. Postoperatively, mean forward elevation was 162.8 degrees and external rotation was 44.6 degrees. All patients returned to their previous occupation. None reported to be having any recurrent subluxation post-surgery. The mean ASES score was 92.5 while the mean WOSIS score was 76.84%. Only one patient had screw backing out from the plate. There was no case of coracoid graft osteolysis. The mini-open Latarjet procedure with graft fixation with Arthrex mini-plate provides satisfactory outcome and stabilization in patients who present with dramatic bone loss and failed soft tissue reconstruction. It not only ensures early rehabilitation but also minimum loss of external rotation. The only drawback is the relatively high cost of the implant

The purpose of this study was to report the results of the vertical apical suture Bankart lesion repair. Fifty-nine patients (52 men and seven women) with a mean age of twenty-seven years (range, 16–53 years) underwent this procedure. The mean duration of instability was 4 years and mean follow-up was 42 months (minimum of two years). A laterally based T-shape capsular incision is performed with the horizontal component directed towards the glenoid neck and into the Bankart lesion. A vertical apical suture through the superior and inferior flaps of the Bankart lesion, tighten the anterior structures to allow them to snug onto the convex decorticated surface of the anterior glenoid. At final review, according to the system of Rowe et al., 94.9% (56 patients) had a rating of good or excellent. Three patients had a recurrent dislocation due to further trauma. The mean loss of forward elevation was 1 degree, external rotation with the arm at the side was 2.4 degrees and external rotation in 90 degrees abduction was 2.2 degrees. Of forty-four patients participating in sport, thirty-five (79.5%) returned to the same sport at the same level of activity, even returned to the same sport at a reduced level of activity and two patients did not return to sport. The vertical apical suture repair offers a 94.9 percent success rate in terms of stability, a maintained range of motion and a 79.5% return to pre-injury level of sporting activity. It is technically less demanding than the Bankart procedure. All sutures used are absorbable. Complications related to non-absorbable implants and absorbable anchors and tacks are avoided

Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available. Cite this article: Bone Joint J 2024;106-B(10):1100–1110

The February 2015 Shoulder & Elbow Roundup. 360 . looks at: Proximal Humerus fractures a comprehensive review, Predicting complications in shoulder ORIF, The Coronoid Revisited, Remplissage and bankart repair for Hill-Sach’s lesions, Diabetes and elbow arthroplasty, Salvage surgery for failed bankart repair, Sternoclavicular Joint Reconstruction, Steroids effective in the short-term for tennis elbow

Background:. Individuals with large Hill-Sachs lesions may be prone to failure and reoccurrence following standard arthroscopic Bankart repair. Here, the Remplissage procedure may promote shoulder stability through infraspinatus capsulo-tenodesis directly into the lesion. Little biomechanicaldata about the Remplissage procedure on glenohumeral kinematics, stability, and range of motion (ROM) currently exists. Questions/purposes:. What are the biomechanical effects of Bankart and Remplissage repair for large Hill-Sachs lesions?. Methods:. Six cadaveric shoulders were tested using a custom shoulder testing system. ROM and glenohumeral translation with applied loads in anterior-posterior (AP) and superior-inferior (SI) directions were quantified at 0° and 60° gleno-humeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40% Hill-Sachs lesion, Bankart repair, Bankart repair with Remplissage, and Remplissage repair alone. Results:. Humeral external rotation (ER) and total range of motion (TR) increased significantly from intact after the creation of the Bankart lesion at both 0° abduction (ER +27.0°, TR +35.8°, p < 0.05) [Fig 1] and 60° abduction (ER +9.5°, TR +30.7°, p < 0.05) [Fig 2], but did not increase further with the addition of the Hill-Sachs lesion. The Bankart repair restored range of motion to intact values 0° abduction at addition of the Remplissage repair did not significantly alter range of motion from the Bankart repair alone. There were no significant changes in AP or SI translation between Bankart repair with and without Remplissage compared to the intact specimen. Conclusions:. The addition of the Remplissage procedure for treatment of large Hill-Sachs lesions had no statistically significant effect on ROM or translation for treatment for large Hill-Sachs lesions. Clinical Relevance: The Remplissage technique may be a suitable option for engaging Hill-Sachs lesions. Further clinical studies are warranted

Acute Hill-Sachs (HS) reduction represents a potential alternative method to remplissage for the treatment of an engaging HS lesion. The purpose of this study is to biomechanically compare the stabilising effects of a acute HS reduction technique and remplissage in a complex instability model. This was a comparative cadaveric study of 6 shoulders. For the acute HS lesion, a unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface in a more anatomic fashion. In addition, a 15% glenoid defect was made in all specimens. The HS lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with Quickset (Arthrex) bone cement to prevent plastic deformation. Five scenarios were tested; intact specimen, bipolar lesion, Bankart repair, remplissage with Bankart repair and HS reduction technique with Bankart repair. Translation, kinematics and dislocation events were recorded. For all 6 specimens no dislocations occurred after either remplissage or the reduction technique. At 90 degrees of abduction and external rotation (ABER), anterior-inferior translation was 11.1 mm (SD 0.9) for the bipolar lesion. This was significantly reduced following both remplissage (5.1±0.7mm; p<0.001) and HS reduction (4.4±0.3mm; p<0.001). For anterior-inferior translation there was no significant difference in translation between the reduction technique and remplissage (p=0.91). At 90 degrees of ABER, the intact specimens average joint stiffness was 7.0±1.0N/mm, which was not significantly different from the remplissage (7.8±0.9 N/mm; p=0.9) and reduction technique (9.1±0.6 N/mm; p=0.50). Compared with an isolated Bankart repair, the average external rotation loss after also performing a remplissage procedure was 4.3±3.5 deg (p=0.65), while average ER loss following HS reduction was 1.1±3.3 deg (p=0.99). There was no significant difference in external rotation between remplissage and the reduction technique (p=0.83). Similar joint stability was conferred following both procedures, though remplissage had 3.2-degree loss of ER in comparison. While not statistically significant, even slight ER loss may be clinically detrimental in overhead athletes. Overall, the acute reduction technique is a more anatomic alternative to the remplissage procedure with similar ability to prevent dislocation in a biomechanical model, making it a viable treatment option for engaging Hill-Sachs lesions

Concepts in glenoid tracking and treatment strategies of glenoid bone loss are well established. Initial observations in our practice in Singapore showed few patients with major bone loss requiring glenoid reconstructions. This led us to investigate the incidence of and the extent of bone loss in our patients with shoulder instability. Our study revealed bony Bankart lesions were seen in 46% of our patients but glenoid bone loss measured only 6–10% of the glenoid surface. In the same study we found that arthroscopic labral repair with capsular plication and Mason-Ellen suturing (Hybrid technique) was sufficient to stabilise patients with bipolar bone defects and minor glenoid bone loss. This led us to develop the concept of minor bone loss and a new algorithm. Our algorithm and strategies to deal with major bone loss will also be discussed, and techniques & outcomes of Arthroscopic Bony Bankart repair, Arthroscopic Glenoid Reconstruction and Arthroscopic Remplissage procedures will be shown

Currently there is no standard quantitative methodology for the description of Hill-Sachs defects (HSD), the size of which is important in planning surgical treatment for patients with anterior shoulder instability. The main purpose was to develop a simple imaging measurement to improve communication regarding HSDs. The secondary goal was to determine, using this new measurement, whether there was a significant difference in the size of HSDs in patients who underwent a Weber osteotomy (more invasive surgical intervention for those failing Bankart repair) compared with patients who underwent clinically successful arthroscopic Bankart repairs (the first surgical intervention for anterior shoulder instability). HSD volume was calculated with newly developed methodology using computed tomography in ten patients who required eleven Weber osteotomies and using magnetic resonance imaging in twenty-two patients who had clinically successful arthroscopic Bankart repairs. Within the Weber cohort, regression analysis was performed to determine correlation between HSD volume and each of height, maximum depth, and width. Student's t-test analysis was used to compare HSD volume between the Weber and Bankart cohorts. In the Weber cohort, there is a statistically significant correlation between the HSD Volume Ratio and the HSD Maximum Depth Ratio (R. 2. =0.83). The t-test comparison of mean HSD Volumes showed statistically significant (p<0.0015) larger HSD's in the Weber cohort than the Bankart cohort. HSD depth is a radiological indicator for HSD volume. This simple measurement may facilitate orthopaedic pre-operative planning for patients with severe recurrent anterior shoulder instability. In this preliminary study, patients who had Weber osteotomies after failed Bankart repairs had statistically significantly larger HSDs than patients with clinically successful Bankart repairs

Purpose. The remplissage procedure may be performed as an adjunct to Bankart repair to address an engaging Hill-Sachs defect. Clinically, it has been reported that the remplissage procedure improves joint stability but that it may also restrict shoulder range of motion. The purpose of this biomechanical study was to examine the effects of the remplissage procedure on shoulder motion and stability. We hypothesized that the remplissage procedure would improve stability and prevent engagement but may have a deleterious effect on motion. Method. Eight cadaveric forequarters were mounted on a custom biomechanical testing apparatus which applied simulated loads independently to the rotator cuff muscles and to the anterior, middle and posterior deltoid. The testing conditions included: intact shoulder, Bankart defect, Bankart repair, 2 Hill-Sachs defects (15%, 30%) with and without remplissage. Joint range of motion and translation were recorded with an optical tracking system. Outcomes measured were internal-external rotation range of motion in adduction and 90 combined abduction, extension range of motion and stability, quantified in terms of joint stiffness and engagement, in abduction. Results. With a 15% Hill-Sachs defect, the remplissage significantly reduced internal-external rotation in adduction (15.111.1, p=0.039), but not in abduction (7.79.0, p=0.380). In a 30% Hill-Sachs defect, the remplissage procedure significantly reduced internal-external rotation in adduction (19.57.8, p=0.001), and in abduction (12.28.6, p=0.03). The remplissage procedure significantly enhanced stability in the 15% Hill-Sachs defect (4.74.0 N/mm, p=0.038), and in the 30% defect (3.93.2 N/mm, P=0.030) compared to the unrepaired defect. All of the unrepaired 30% defects engaged and the remplissage procedure successfully eliminated engagement in each case. However, impingement of the repair on the posterior glenoid with paradoxical posterior pivoting of the humeral head was observed in 50% of the specimens. Conclusion. The remplissage procedure significantly augmented a Bankart repair in 15% and 30% Hill-Sachs defects and, in 30% Hill-Sachs defects, the remplissage successfully prevented engagement of the defect. The remplissage procedure, however, did significantly reduced shoulder internal-external rotation range of motion as reported clinically, and was also found to reduce extension in the two defect groups. During extension the intra-articular soft tissue bumper created by the remplissage procedure was found to impinge on the posterior glenoid rim and cause pivoting, which produced non-physiologic glenohumeral joint distraction. Therefore, the remplissage procedure stabilized the joint to a significantly greater degree than did a Bankart repair alone; however, it also significantly reduced shoulder range of motion