Anterior shoulder instability with engaging Hill Sachs lesion treated with isolated bankart repair vs. bankart repair and remplissage technique

Author(s): Paarth Narula, Vinod Nair, Sanjay Deo, Swaroop Solunke, Amol Patil, Avinash Kumar

Introduction: Recurrent shoulder dislocation account for a common problem in young patients. Bankart lesion is described as injury to anterior (inferior) glenoid labrum due to anterior shoulder dislocation leading to formation of a pocket in front of glenoid that allows humeral head to dislocate into it. It is often accompanied with hill sach lesion which is compression fracture of the posterolateral humeral head due to its compression against the anteroinferior part of the glenoid. Material and Methods: Around 20 cases of recurrent anterior shoulder dislocation treated isolated arthroscopic bankart repair or arthroscopic bankart andremplissage technique. 6 months follow up is done. Arthroscope was inserted via a routine posterior portal for evaluation of Bankart and Hill-Sachs lesions. Two standard anterior portals were also put. Through the anterior portal, Bankart repair was done after freshening and elevating the labrum, and then anchors of 2.8 mm were used to repair labrum to the glenoid. And for Hill Sachs lesion, posterior portal put 2.5 cm below the anterior portal. A bone shaver was used to debride the humeral defect, following which a double loaded 5 mm anchor was placed. Lastly, suture replacement was done to fix only the tendinous element of infraspinatous tendon to the defect. In post op physiotherapy is started after 3 weeks, as per pain tolerance by the patient. Discussion: Bankart and remplissage associated with better outcome and lesser complications compared to isolated bankart repair. Average time for full range of motion of soulder is 6 weeks. Conclusion: Arthroscopic bankart repair and remplissage technique is better than isolated arthroscopic bankart repair.