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Erschienen in:
01.09.2015 | Original Article
Recurrent anterior shoulder dislocation with engaging Hill–Sachs defect: remplissage or Latarjet?
Erschienen in: European Orthopaedics and Traumatology | Ausgabe 3/2015
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Introduction
Burkhart and De Beer were the first to conclude that arthroscopic Bankart repair in the presence of engaging Hill–Sachs defect is likely to fail and requires open surgery. To prevent this engagement, the Hill–Sachs lesion can either be made extraarticular by arthroscopic posterior capsulodesis and infraspinatus tenodesis to fill (remplissage) the Hill–Sachs lesion in addition to an arthroscopic Bankart repair or the functional glenoid arc can be lengthened by a coracoid transfer procedure to make the defect non-engaging.
Objectives
The purpose of this study was to compare the clinical outcome and cost-effectiveness of arthroscopic remplissage versus open Latarjet procedure in cases of recurrent shoulder dislocation with large engaging Hill–Sachs lesion.
Patients and methods
This comparative prospective study was conducted on 32 patients with a mean age of 28.2 years. Odd number patients had a modified Latarjet procedure and even number patients had arthroscopic remplissage procedure with capsulolabral repair using four anchors.
Results
The mean follow-up period was 31.31 months. Rowe score increased from a mean of 28.75 to 84.62 in the Latarjet group and from a mean of 26.12 to 86.62 in the remplissage group. The difference had no statistical significance. The only limitation in range of motion for both groups was in external rotation in abduction. Cost of the implants was tenfold more for the remplissage group.
Conclusion
Open modified Latarjet and arthroscopic remplissage procedure with Bankart repair are equally effective in prevention of dislocation in patients with recurrent anterior shoulder dislocation and engaging Hill–Sachs lesion.