Remplissage reduces recurrent instability in high-risk patients with on-track Hill-Sachs lesions

Background: The purpose of this study was to compare recurrent instability rates between patients with on-track Hill-Sachs lesions who underwent arthroscopic labral repair (ALR) alone and those who underwent ALR with remplissage (ALR-R). Our hypothesis was that ALR-R would decrease the rate of recurrent instability, especially among patients at high risk of recurrent instability after ALR, such as contact athletes with near-track Hill-Sachs lesions. Methods: We performed a multicenter, retrospective analysis of patients aged 14-50 years with on-track Hill-Sachs lesions who underwent ALR-R or ALR without remplissage between January 2014 and December 2019 with minimum 2-year follow-up. The exclusion criteria included prior ipsilateral shoulder surgery, >15% glenoid bone loss (GBL), off-track Hill-Sachs lesion, concomitant shoulder procedure, and connective tissue disorder. Age, sex, follow-up, and contact sports participation were recorded. GBL, Hills-Sachs interval (HSI), glenoid track, and distance to dislocation ( DTD) were determined from preoperative magnetic resonance imaging scans. Affected-shoulder range of motion, Western Ontario Shoulder Instability Index scores, Subjective Shoulder Value scores, and recurrent dislocation and/or revision surgery status were also collected. A subgroup analysis was performed on ''high-risk'' patients (defined as participants in contact sports with DTD <10 mm) from each cohort. Results: The ALR-R cohort included 56 patients, and the ALR cohort included 127. ALR-R patients had greater GBL (P=.004) and a greater HSI (P <.001). In the ALR-R cohort, only 1 patient (1.8%) had a recurrent dislocation and there were no revision operations. In comparison, in the ALR cohort, 14 patients (11.0%) had recurrent dislocations (P=.040) and 8 (6.3%) underwent revision operations (P=.11). Univariate analysis showed that remplissage protected against recurrent dislocation (P=.040) whereas younger age (P=.004), contact sports participation (P=.001), and increased GBL (P=.048) were associated with recurrent dislocation. Multivariate analysis showed that HSI (P=.001) and contact sports participation (P=.002) predicted recurrent dislocation. Among high-risk patients, only 1 patient (4.2%) in the ALR-R group had a recurrent instability event vs. 6 (66.7%) in the ALR group (P <.001). The high-risk ALR-R subgroup also had significantly better final Western Ontario Shoulder Instability Index (P=.008) and Subjective Shoulder Value (P=.001) scores than the high-risk ALR subgroup. Conclusions: Anterior shoulder instability patients with on-track Hill-Sachs lesions have lower recurrent dislocation rates after ALR plus remplissage when compared with ALR alone. This is especially true for high-risk patients, such as contact athletes with a DTD <10 mm. Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study (C) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.