Effect of Remplissage procedure on external rotation of shoulder for Bankart injury with Hill-Sachs lesion: A meta-analysis

  Background  The Rempllisage procedure can significantly decrease the recurrence rate of postoperative dislocation in patients with Bankart injury combined Hill-Sachs lesion, but there is no consensus about the effect of this procedure on external rotation of shoulder.

  Objective  To systematically evaluate the effect of Arthroscopic Rempllisage procedure on external rotation of the shoulder joint for Bankart lesion with Hill-Sachs lesion.

  Methods  Chinese and English literatures related to the surgery of Remplissage were searched from May 2008 to December 2019 in CNKI, WAN-FANG, CQVIP, PubMed, Embase and Web of Science. Quality assessment for all included clinical studies was performed using the Methodological Index for NonRandomized Studies (MINORS) scoring system. The effect of Remplissage on external rotation of the shoulder was evaluated.

  Results  Fifteen articles were enrolled in the study, of which ten articles were in English (66.7%), five in Chinese (33.3%). For level of evidence, three studies were rated at Level Ⅲ (20%), and 12 were Level Ⅳ (80%). Totally 673 patients (674 shoulders) were included, of which 546 cases underwent Bankart repair with Remplissage procedure (B + R, 81.1%), 127 patients had isolated Bankart repair (B, 18.9%). Meta analysis showed that the average limit of lateral external rotation after (B + R) was 8.6^o (P＜0.001), but the external rotation at 90^o abduction had no statistical difference when compared with preoperative values (P=0.054). Compared with isolated Bankart repair, (B + R) had more severe impact of limiting external rotation on the shoulder joint by 0.74^o without significant difference (P=0.078).

  Conclusion  Bankart repair with Remplissage procedure will partially limit the external rotation function, and the surgical indications should be considered carefully according to the injury before surgery.