title: Primary versus revision arthroscopic reconstruction with remplissage for shoulder instability with moderate bone loss.
abstract: OBJECTIVE
  This study aims to evaluate our outcomes of arthroscopic remplissage in this setting.
  
  
  METHODS
  A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score.
  
  
  RESULTS
  Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001).
  
  
  CONCLUSIONS
  In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
authors.forename: Michael P
authors.initials: MP
authors.lastname: McCabe
authors.affiliation: Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
authors.forename: Douglas
authors.initials: D
authors.lastname: Weinberg
authors.affiliation: Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Field
authors.affiliation: Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Brien
authors.affiliation: Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.
authors.forename: E Rhett
authors.initials: ER
authors.lastname: Hobgood
authors.affiliation: Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A. Electronic address: fsavoie@tulane.edu.
authors.forename: Felix H
authors.initials: FH
authors.lastname: Savoie
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001862:Bone Resorption / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D055815:Young Adult