Remplissage Versus Modified Latarjet For Off-Track Hill-Sachs Lesions With Subcritical Glenoid Bone Loss

OBJECTIVES: Off track Hill-Sachs lesions have been associated with high rate of recurrent shoulder instability. Both arthroscopic Bankart with Remplissage and modified Latarjet have been described to treat off-track Hill-Sachs lesions. However, few comparative studies exist between the two techniques in heterogeneous populations. The purpose of this study was to examine the outcome of the two procedures in patients with off-track Hill-Sachs lesions with subcritical (<25%) glenoid bone loss, both in the primary and revision setting. METHODS: Arthroscopic Bankart with Remplissage was performed in thirty-one patients and modified Latarjet was performed in forty patients with recurrent anterior shoulder instability, off-track Hill-Sachs lesion, and less than 25% glenoid bone loss. Surgeries were performed at two centers. Patients were divided based on if they have had no previous surgical stabilization (Group A) or if they have had one or more previous surgical stabilization (Group B). The mean follow up time was four years. Patients were assessed for their risk of recurrence using the Instability Severity Index score and had preoperative 3-dimensional imaging to assess humeral and glenoid bone loss. Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), radiographs, range of motion, recurrence rate, subsequent procedures and complications were analyzed. RESULTS: In the thirty-two patients of group A, seventeen had remplissage and fifteen had Latarjet performed. Within group A, there were no difference found between the two techniques in regards to SANE, WOSI, range of motion (p>0.35). There were no complications, recurrence or revision with both techniques in group A. In the thirty-nine patients of group B, fourteen had remplissage and twenty-five had Latarjet performed. In group B, the reoperation surgery rate was significantly higher in the remplissage group (36% vs 8%, p=0.044). The reoperation was performed predominately for pain in patients with remplissage and for recurrent instability with Latarjet. Recurrence instability rate were similar between the remplissage and Latarjet group (14% vs 8%, p=0.45). The WOSI score was similar between the remplissage and Latarjet group (405 vs 461, p=0.66). The complication rate was also similar (36% vs 40%, p=1). CONCLUSION: For off-track Hill-Sachs lesions with subcritical glenoid bone loss, both the remplissage and modified Latarjet can achieve excellent clinical results in the primary setting (no previous instability surgery). However, in the revision setting (one or more previous instability surgery), patients with remplissage may have a higher reoperation rate.