Outcomes of The Remplissage Procedure and Its Effects on Return to Sports

摘要

Objectives: Short-term outcomes for remplissage patients with large engaging Hill-Sachs lesions have demonstrated good results. However, limited data is available for longer-term outcomes. The purpose of this study was to evaluate long-term outcomes of the remplissage and determine the long-term rate of return to specific sports postoperatively. Methods: This was a retrospective review of patients treated with the remplissage procedure from 2007-2013. All had preoperative MRIs demonstrating large Hill-Sachs lesions by Rowe criteria and glenoid bone loss less than 20%. All Hill-Sachs lesions were “off track” by arthroscopic examination and preoperative imaging. At final follow up, patients had a ROM evaluation and were administered a detailed outcomes survey, which included WOSI and ASES as well as questions regarding sports, employment, physical activities and dislocation events. Results: Fifty-one shoulders (50 patients) were included. Average age at surgery was 29.8 years (15.0-72.4 years) and average follow up was 60.7 months (25.5-97.6 months). 20% of patients had previous surgery on their shoulder. Average postoperative WOSI scores were 79.5% and average ASES scores were 89.3. Six shoulders had dislocation events (11.7%) postoperatively: three were traumatic, and three atraumatic. Increasing number of preoperative dislocations increased the risk of a postoperative dislocation (p<0.001). There was also a trend towards higher postoperative dislocation rates in revision patients (p=0.062). Average loss of external rotation was 5.2 degrees (p=0.13). 95.5% of patients returned to one or more sports postoperatively at an average of 7.0 months. 81.0% returned to their previous intensity and level of sport. 65.5% (19) of patients who played a throwing sport stated they had problems throwing. 58.6% (17) felt they could not normally wind up throwing a ball. Direct rates of return for overhead sports were volleyball 100%, basketball 69%, baseball 50% and football 50%. Conclusion: Remplissage’s re-dislocation rate was 11.7% at an average of five years, with 96% of patients returning to full sports at an average of 7 months. For throwing sports, 65.5% complain of decreased range of motion during throwing. The results should be considered preoperatively in remplissage candidates who are engaged in throwing sports.