Background: Recent literature has shown that inferior Hill-Sachs extension for on-track shoulders is predictive of recurrent instability after arthroscopic Bankart repair alone. Specifically, there is a high risk for recurrent instability when the lesion extends below the humeral equator on sagittal magnetic resonance imaging. This worrisome inferior extension has been termed “critical humeral bone loss (CHBL).” Remplissage has yet to be explored as a potential useful augmentation in patients with CHBL. Hypothesis: The addition of remplissage would decrease recurrence rates for Hill-Sachs lesions with inferior extension or CHBL compared with arthroscopic Bankart repair alone in patients with on-track Hill-Sachs lesions. Study Design: Case series; Level of evidence, 4 Methods: Retrospective analysis was performed on the records of patients who underwent primary arthroscopic Bankart repair with or without the addition of remplissage from 2007 to 2021. Off-track shoulders, revision stabilization, glenoid bone loss (GBL) >20%, and those with follow-up <2 years or incomplete medical data were excluded. The primary outcome was recurrent instability, defined as either postoperative dislocation or subluxation. The Hill-Sachs position was measured relative to the humeral axis on sagittal magnetic resonance imaging as previously described. Univariate and multivariate logistic regression analyses were implemented to determine the protective effect of remplissage. Results: A total of 219 patients were included for analysis with a mean age of 21.1 years (range, 12.9-40.5 years) and mean follow-up of 7.0 years (range, 2-14.4 years); 44 patients (20%) underwent remplissage in addition to arthroscopic Bankart. In multivariate analysis, remplissage significantly reduced the risk of recurrent instability (OR, 0.06; P = .002) and CHBL was a significant predictor of recurrent instability (OR, 3.0; P = .029) while adjusting for age, multiple preoperative dislocations, contact athlete status, and percent GBL. When stratified by CHBL, remplissage remained protective (OR, 0.013; P = .007) against recurrent instability. Conclusion: The addition of a remplissage for CHBL in patients with subcritical GBL and on-track Hill-Sachs lesions reduces the risk of recurrent instability in patients undergoing arthroscopic Bankart repair.

中文翻译：

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在关节镜 Bankart 修复术中加入 Remplissage 及其对肩部复发性不稳定伴严重肱骨丢失的影响

背景： 最近的文献表明，赛道上肩部的下侧 Hill-Sachs 伸展可预测单独关节镜下 Bankart 修复后复发性不稳定。具体来说，当矢状磁共振成像上病变延伸到肱骨赤道以下时，存在复发性不稳定的高风险。这种令人担忧的下延伸被称为“严重肱骨丢失 （CHBL）”。Remplissage 尚未被探索为 CHBL 患者的潜在有用增强。假设：在轨道上 Hill-Sachs 病变患者中，与单独关节镜下 Bankart 修复相比，添加 remplissage 会降低下延伸或 CHBL 的 Hill-Sachs 病变的复发率。研究设计：病例系列;证据水平，4 方法 对 2007 年至 2021 年接受初次关节镜 Bankart 修复术（有或没有增加 remplissage）的患者的记录进行回顾性分析。排除了偏离轨道的肩膀、翻修稳定、关节盂骨丢失 （GBL） >20% 以及随访 <2 年或医疗数据不完整的患者。主要结局是复发性不稳定，定义为术后脱位或半脱位。如前所述，在矢状磁共振成像上相对于肱骨轴测量 Hill-Sachs 位置。实施单因素和多因素 logistic 回归分析以确定 remplissage 的保护作用。结果： 共纳入 219 例患者进行分析，平均年龄为 21.1 岁 （范围，12.9-40.5 岁），平均随访时间为 7.0 年 （范围，2-14.4 年）;44 例患者 （20%） 除了关节镜 Bankart 外还接受了 remplissage。 在多变量分析中，remplissage 显著降低了复发性不稳定的风险 （OR，0.06;P = .002），CHBL 是复发性不稳定的重要预测因子 （OR，3.0;P = .029），同时调整年龄、多发性术前脱位、接触运动员状态和 GBL 百分比。当按 CHBL 分层时，remplissage 仍然具有保护性 （OR，0.013;P = .007） 对抗复发性不稳定。结论： 在亚临界 GBL 和轨道上 Hill-Sachs 病变患者中增加 CHBL 的剂量可降低接受关节镜 Bankart 修复术的患者复发不稳定的风险。