Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage

HSS Journal - Volume 11, Number 2, July 2015

Grant H. Garcia, MD
Hospital for Special Surgery, New York, NY

Min Jung Park, MD, MMSc.
Southern California Permanente Medical Group, Los Angeles, CA, USA

Clare Zhang MD
Hospital of the University of Pennsylvania, Philadelphia, PA

John D. Kelly IV, MD
Hospital of the University of Pennsylvania, Philadelphia, PA

G. Russell Huffman, MD, MPH
Hospital of the University of Pennsylvania, Philadelphia, PA


There is little comparative long-term clinical data comparing Bankart repair alone to the addition of remplissage.

Our purpose was to compare results of patients with significant humeral head lesions and who underwent either isolated arthroscopic Bankart repair or remplissage.

This is a retrospective cohort study of 14 isolated arthroscopic Bankart and 10 remplissage repairs all with large engaging Hill-Sachs (HS) lesions. Average follow-up was 40.72 months (26.3–51.1) in the Bankart group and 31.55 months (24.1–39.9) in the remplissage group. Surgical failure was defined as a dislocation or subluxation. Groups were matched on handedness, age within 3 years, and HS lesion size. Glenoid bone loss and HS size were measured on MRI. Additionally, WOSI and DASH scores were obtained.

The average age at surgery was 26.0 years (17.8–41.1) of the isolated Bankart patient and 24.4 years (16.4–38.3) in the remplissage group. The average HS lesion volume was 310.22 mm3 in the Bankart group and 283.79 mm3 in the remplissage group. The failure rate for the Bankart group was 8 out of 14 patients (57.14%). For the remplissage group, the failure rate was 2 out of 10 patients (20.0%). Average WOSI scores were 73.72 in the Bankart group and 79.54 in the remplissage group. For DASH scores, the average Disability/Symptoms Scores were 16.23 for the Bankart group and 12.05 for the remplissage patients.

In comparison to isolated Bankart repair, remplissage was a superior option for recurrent instability patients with large Hill-Sachs lesions as seen by diminished failure rates and improved outcome scores.

Level of Evidence: Therapeutic Level III

This article appears in HSS Journal: Volume 11, Number 2.
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About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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