Bankart repair with remplissage vs. Latarjet procedure on recurrence, postoperative pain scores, external rotation, and Rowe score in patients with a Hill-Sachs lesion. A systematic review

Background: Currently, recurrent anterior shoulder instability in patients with a Hill-Sachs lesion managed using the Bankart repair showed higher recurrent instability compared with the Latarjet technique. Addition of posterior capsulodesis with infraspinatus remplissage to the Bankart repair, known as Bankart with remplissage (BR), increases shoulder stability in patients with a Hill-Sachs lesion. BR can potentially match the low recurrence rates of the Latarjet procedure while being less invasive. This systematic review compares the Bankart repair with remplissage and Latarjet procedure on postoperative pain, external rotation range of motion, and recurrent instability in anterior shoulder instability patients with a Hill-Sachs lesion. Methods: A systematic search of the PubMed, Web of Science, and Cochrane Library databases was performed. Studies comparing BR and Latarjet on recurrent instability and/or visual analogue scale (VAS) pain score in anterior shoulder instability patients with a Hill-Sachs lesion were included. Expert opinion, conference presentations, editorials, abstracts, case reports, and nonclinical studies were excluded. Records were initially screened by title and abstract, during the second screening full text was consulted. Study quality was examined using the Methodological Index for Nonrandomized Studies criteria. Risk ratios were calculated for recurrent instability, and standardized mean difference (Cohen's d) were calculated for VAS pain, external rotation, and Rowe score. Results: Eight of the 146 studies were included in the analysis. The study population consisted of a total of 845 patients, of whom 450 patients underwent the Latarjet procedure and 395 patients underwent BR. Three studies included revision surgery patients; more revision surgery patients were allocated to the Latarjet group. Risk ratios for recurrent instability varied from 0.45 to 2.41. Effect size varied for VAS pain from -2.28 to 0.04, for external rotation from -1.44 to 1.12, and for Rowe score from -0.67 to 1.37. Limitations of the included studies were differences in baseline demographics and functional outcomes. Conclusion: Recurrent instability seems equal between BR and Latarjet in patients with a Hill-Sachs lesion depth <10 mm. Latarjet showed superior external rotation than BR. Future research should examine patient demographics optimal for minimizing recurrent instability using BR.