Arthroscopic "Remplissage" for shoulder instability: a systematic review.
OBJECTIVE
Large Hill-Sachs lesions engaging the glenoid rim predispose to recurrent anterior instability and failure of isolated labrum repairs. In arthroscopic remplissage, the posterior capsule and infraspinatus are sutured into the humeral defect to limit such engagement. This systematic review assessed the outcomes and complications of arthroscopic remplissage for anterior shoulder instability.


METHODS
A search of the MEDLINE, EMBASE and evidence-based medicine Cochrane databases was conducted. Data were extracted by two reviewers in a standardised manner. Redislocation, instability and complication rates were calculated and expressed as percentages with 95 % confidence intervals.


RESULTS
Of 4,284 studies identified, eight articles with a total of 207 patients were analysed. Mean redislocation rate was 4.2 ± 3.9 % (range 0-15 %), and mean recurrent instability rate 3.2 ± 3.8 % (0-15 %). Posterosuperior shoulder pain and stiffness were the only complications described. Overall, there was a mean reduction in external rotation in adduction of 5.6° (-40 to +30), reduction in external rotation in abduction of 11.3° (-50 to +7) and reduction in internal rotation of 0.9 (-4 to 0) vertebral levels.


CONCLUSIONS
Arthroscopic remplissage alongside anterior labrum repair seems successful in treating recurrent shoulder instability in the presence of large or engaging Hill-Sachs lesion. However, the available literature consists mainly of heterogeneous case series. There is a need for a high-quality randomised trial to compare remplissage with other commonly used techniques for recurrent instability associated with substantial Hill-Sachs defects such as the Latarjet procedure.


METHODS
Systematic review, Level IV.
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Mustafa S
MS
Rashid
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
James
J
Crichton
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Usman
U
Butt
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
Pavel I
PI
Akimau
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK. bcharalambos@hotmail.com.
Charalambos P
CP
Charalambous
D001182:Arthroscopy; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D018482:Muscle, Skeletal / Q000601:surgery; D012008:Recurrence; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*
Arthroscopic; Dislocation; Remplissage; Shoulder instability