COMPARATIVE STUDY on the MANAGEMENT of GLENOHUMERAL JOINT DISLOCATION. Closed Reduction vs. Arthroscopic Remplissage with Bankart Lesion Repair.

BACKGROUND: Conservative treatment of posttraumatic anteroinferior shoulder instability leads to a high failure rate and consequently high recurrence in young and active population. Each recurrence can increase the structural damage of both bony structures and soft tissues (Hill-Sachs lesion, Bankart lesion). Remplissage technique combined with Bankart repair have been proposed as a treatment option.

HYPOTHESIS: Early arthroscopic treatment for shoulder dislocation will result in better outcome and lower recurrence rate than nonoperative management.

METHODS: We retrospectively reviewed 60 cases from 2010 to 2015 treated by remplissage technique with Bankart repair or closed reduction for anterior shoulder dislocation. All surgeries and closed reductions were done by the same surgeon. Mean age of patients was 30 years, most of them males having experienced one or more recurrent dislocations; mean follow-up was 2 years. Patients with Hill-Sachs lesions < 40% on the articular surface and < 20% of bone defect in the glenoid cavity were included. Exclusion criteria were: glenohumeral arthritis or other inflammation, fracture around the shoulder joint, elderly patients with osteoporosis. All patients included in the study were followed up after 6, 12 and 24 months. Rowe score was used to assess the stability of the shoulders and goniometry to assess the range of motion of the glenohumeral joints.

RESULTS: The results confirm that the remplissage technique with Bankart repair takes the upper hand over the conservative management and does not produce any severe adverse effect on postoperative shoulder range of motion. A slight restriction (≈10º) observed in external rotation did not prevent 69% of patients from resuming their preinjury sports activities. At the last follow-up, 90% of patients had a stable shoulder. Conservative management was associated with high rate of recurrence limiting the daily activity of our patients and interfering with their return to sports activities. Except from the recurrence of glenohumeral instability, no patient had a complication following arthroscopic Hill-Sachs remplissage.

CONCLUSION: Conservative management after anterior shoulder dislocation including immobilization in neutral position leads to significantly higher and unacceptable high failure rate compared with early arthroscopic remplissage with Bankart repair. The slight restriction in external rotation post remplissage does not significantly affect the quality of life and return to sports activities and further supports the use of this safe, relatively short procedure, in the management of glenohumeral instability with concurrent Hill-Sachs lesions.