No Difference in External Rotation Loss After Isolated Bankart Repair, Remplissage, or Latarjet: A Systematic Review and Meta-analysis

Background: Despite the effectiveness of remplissage in reducing instability recurrence, debate remains about the loss of external rotation (ER) after this procedure.Purpose: To compare the loss of ER after primary isolated arthroscopic Bankart repair alone (BR), Bankart with remplissage (REMP), and Latarjet (LAT) procedures.Study Design: Meta-analysis; Level of evidence, 3.Methods: A literature search of 4 databases was conducted to identify comparative studies reporting ER after BR, REMP, or LAT. ER loss with the arm at side was collected, along with postoperative Rowe score, return to previous sport level, instability recurrence, reintervention, and noninstability complications. Dichotomous variables were assessed using odds ratios with 95% CIs, and continuous variables were analyzed using mean differences (MDs) with 95% CIs. A random-effects meta-analysis was used for continuous outcomes and dichotomous outcomes.Results: In total, 27 studies were included, consisting of 2100 patients: 824 in BR, 378 in REMP, and 898 in LAT groups. The mean ER loss was 6.8 degrees +/- 11 degrees after BR, 9.3 degrees +/- 12.6 degrees after REMP, and 0.8 degrees +/- 20.4 degrees after LAT. Comparing REMP and BR, the MD was 5.9 degrees (P = .13); between REMP and LAT, the MD was 9.6 degrees (P = .17). For Rowe scores, the MD was 3.46 (P = .49) between REMP and BR and 0.24 (P = .9) between REMP and LAT. Odds ratios for return to previous sport level were 1.08 (P = .84) for REMP versus BR and 1.62 (P = .09) for REMP versus LAT. Regarding instability recurrence, the odds ratio was 6.67 (P = .04) for REMP versus BR and 1.43 (P = .48) for REMP versus LAT. The odds ratio for reoperation for BR was 7.69 (P = .05) compared with REMP, and the odds ratio for complications for LAT was 6.25 (P = .02) compared with REMP.Conclusion: Remplissage reduces instability recurrence compared with isolated Bankart repair without any statistically significant difference in postoperative ER deficit. Remplissage may reduce the risk of reoperation compared with Latarjet with no difference in postoperative ER deficit or recurrence.