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Arthroscopic “Remplissage” for shoulder instability: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Large Hill–Sachs lesions engaging the glenoid rim predispose to recurrent anterior instability and failure of isolated labrum repairs. In arthroscopic remplissage, the posterior capsule and infraspinatus are sutured into the humeral defect to limit such engagement. This systematic review assessed the outcomes and complications of arthroscopic remplissage for anterior shoulder instability.

Methods

A search of the MEDLINE, EMBASE and evidence-based medicine Cochrane databases was conducted. Data were extracted by two reviewers in a standardised manner. Redislocation, instability and complication rates were calculated and expressed as percentages with 95 % confidence intervals.

Results

Of 4,284 studies identified, eight articles with a total of 207 patients were analysed. Mean redislocation rate was 4.2 ± 3.9 % (range 0–15 %), and mean recurrent instability rate 3.2 ± 3.8 % (0–15 %). Posterosuperior shoulder pain and stiffness were the only complications described. Overall, there was a mean reduction in external rotation in adduction of 5.6° (−40 to +30), reduction in external rotation in abduction of 11.3° (−50 to +7) and reduction in internal rotation of 0.9 (−4 to 0) vertebral levels.

Conclusions

Arthroscopic remplissage alongside anterior labrum repair seems successful in treating recurrent shoulder instability in the presence of large or engaging Hill–Sachs lesion. However, the available literature consists mainly of heterogeneous case series. There is a need for a high-quality randomised trial to compare remplissage with other commonly used techniques for recurrent instability associated with substantial Hill–Sachs defects such as the Latarjet procedure.

Level of evidence

Systematic review, Level IV.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK

    Mustafa S. Rashid, James Crichton, Usman Butt, Pavel I. Akimau & Charalambos P. Charalambous

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  1. Mustafa S. Rashid
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  2. James Crichton
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  3. Usman Butt
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  4. Pavel I. Akimau
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  5. Charalambos P. Charalambous
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Corresponding author

Correspondence to Charalambos P. Charalambous.

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Rashid, M.S., Crichton, J., Butt, U. et al. Arthroscopic “Remplissage” for shoulder instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 578–584 (2016). https://doi.org/10.1007/s00167-014-2881-0

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  • DOI: https://doi.org/10.1007/s00167-014-2881-0

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