Freshman Ryan, Lurie Benjamin, Garcia Grant, Liu Joseph
USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, 90033, USA.
Proliance Surgeons Orthopedic Specialists of Seattle, 2409 N. 45Th Street, Seattle, WA, 98103 , USA.
Curr Rev Musculoskelet Med. 2024 Jul;17(7):282-291. doi: 10.1007/s12178-024-09900-3. Epub 2024 May 20.
Arthroscopic remplissage has continued to gain popularity as an adjunct to Bankart repair for patients with anterior shoulder instability. Although the original remplissage technique was described over 15 years ago, our understanding of when and how to use this procedure continues to evolve. This article provides a review of how remplissage affects shoulder biomechanics, compares clinical outcomes between remplissage and other procedures for shoulder instability, and discusses current indications for remplissage.
Current research focuses on the use of remplissage across a wide range of glenoid bone loss. Remplissage appears effective at preventing recurrent instability in patients with glenoid bone loss up to 15% of the glenoid width. However, once glenoid bone exceeds 15%, outcomes tend to favor bony reconstruction procedures such as Latarjet. Results of biomechanical studies examining shoulder range of motion (ROM) after remplissage are mixed, though clinical studies tend to report no significant limitations in ROM when remplissage is added to a Bankart repair. Adding a remplissage to conventional Bankart repair may improve clinical outcomes and lower rates of recurrent instability without significantly altering shoulder ROM. However, surgeons should recognize its limitations in treating patients with large amounts of glenoid bone loss and should be prepared to discuss alternative procedures on a case-by-case basis. Absolute indications and contraindications for remplissage are not well defined currently and require further scientific research.
关节镜下充填术作为一种辅助治疗前肩不稳患者Bankart修复术的方法，越来越受到欢迎。尽管最初的充填技术在15年前就已被描述，但我们对何时以及如何使用该手术的理解仍在不断发展。本文综述了充填术如何影响肩部生物力学，比较了充填术与其他治疗肩部不稳手术的临床结果，并讨论了当前充填术的适应证。
当前研究集中在充填术在各种程度的肩胛盂骨缺损中的应用。充填术似乎能有效预防肩胛盂骨缺损达肩胛盂宽度15%的患者复发性不稳。然而，一旦肩胛盂骨缺损超过15%，结果往往更倾向于骨性重建手术，如Latarjet手术。充填术后检查肩部活动范围（ROM）的生物力学研究结果不一，不过临床研究倾向于报告在Bankart修复术中增加充填术时，ROM无明显受限。在传统Bankart修复术中增加充填术可能会改善临床结果并降低复发性不稳的发生率，而不会显著改变肩部ROM。然而，外科医生应认识到其在治疗大量肩胛盂骨缺损患者时的局限性，并应准备好根据具体情况讨论替代手术。目前充填术的绝对适应证和禁忌证尚未明确界定，需要进一步的科学研究。
