Badavath Raja Ramesh, Kumar Thirlapuram Sandeep, Chodavarapu Lalithmohan
Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, IND.
Cureus. 2024 Jun 7;16(6):e61870. doi: 10.7759/cureus.61870. eCollection 2024 Jun.
Background The remarkable range of motion of the shoulder comes at the cost of increased instability, especially anterior instability. Arthroscopic Bankart repair with or without remplissage, which is a minimally invasive surgery, is the preferred treatment for recurrent anterior instability. This study investigated the effectiveness of Bankart repair, with or without remplissage, in restoring function, preventing redislocation, and improving patient satisfaction. Methods A prospective observational study examined 40 patients (19-50 years old) with recurrent anterior instability and MRI-confirmed Bankart or Bankart with Hill-Sachs lesions. Patients underwent arthroscopic Bankart repair with or without remplissage based on the inclusion criteria of this study. Preoperative assessments included demographics, history, physical examination, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, ROWE score, and plain MRI of the shoulder joint. Post-operative radiographs and rehabilitation were advised. Functional recovery was evaluated at three months and six months after surgery. Results All patients underwent Bankart repair. Among them, 22 with engaging Hill-Sachs lesions received an additional remplissage procedure. Both groups showed significant improvements in their functional scores (p<0.05) and returned to their prior activities. However, the additional remplissage group had a slightly reduced mean external rotation (86.59°) compared with the Bankart repair-only group (90°). Notably, the recurrence rate was very low, with only one patient (2.5%) experiencing instability. Conclusion Our study emphasizes the importance of proper capsulolabral tissue elevation to achieve a sufficient labral bump during Bankart repair. This technique allowed us to efficiently use only two suture anchors in 35 cases (87.5%). Additionally, remplissage was performed on all identified engaging Hill-Sachs lesions. We found that proper anchor placement and suturing techniques were crucial for successful Bankart repair. The emphasis on the potential cost benefits of a two-anchor approach is a valuable contribution to the field.
肩关节显著的活动范围是以增加不稳定性为代价的，尤其是前向不稳定。关节镜下Bankart修复术（无论是否联合 remplissage）是一种微创手术，是复发性前向不稳定的首选治疗方法。本研究调查了Bankart修复术（无论是否联合remplissage）在恢复功能、预防再脱位以及提高患者满意度方面的有效性。方法：一项前瞻性观察性研究对40例（年龄19 - 50岁）复发性前向不稳定且MRI证实为Bankart损伤或伴有Hill-Sachs损伤的Bankart损伤患者进行了检查。根据本研究的纳入标准，患者接受了关节镜下Bankart修复术，部分患者联合remplissage。术前评估包括人口统计学资料、病史、体格检查、美国肩肘外科医师学会（ASES）评分、上肢、肩部和手部功能障碍快速评估（DASH）评分、ROWE评分以及肩关节X线平片和MRI。术后建议进行X线检查和康复治疗。在术后3个月和6个月评估功能恢复情况。结果：所有患者均接受了Bankart修复术。其中，22例伴有嵌顿性Hill-Sachs损伤的患者还接受了remplissage手术。两组患者的功能评分均有显著改善（p<0.05），并恢复了之前的活动。然而，联合remplissage组的平均外旋角度（86.59°）略低于单纯Bankart修复组（90°）。值得注意的是，复发率非常低，仅有1例患者（2.5%）出现不稳定。结论：我们的研究强调了在Bankart修复术中适当提升关节囊盂唇组织以获得足够的盂唇隆起的重要性。该技术使我们在35例（87.5%）患者中仅有效地使用了两个缝合锚钉。此外，对所有确诊的嵌顿性Hill-Sachs损伤均进行了remplissage手术。我们发现正确的锚钉放置和缝合技术对于成功的Bankart修复至关重要。强调双锚钉方法潜在的成本效益对该领域是一项有价值的贡献。
