Técnica de remplissage para defectos humerales grandes. Un estudio a medio plazo de cohortes emparejadas

Objective

To determine whether a remplissage procedure in patients with large defects of the humeral head compared to those who undergo arthroscopic Bankart repair for anterior glenohumeral instability decreases the rate of recurrence of instability.

Methods

A retrospective matched cohort study of a group of subjects prospectively evaluated with a minimum follow-up of 4 years. Subjects with large humeral Hill-Sachs defects (> 25% of the humeral head, n = 42) were included. Those in which a remplissage had be performed (n = 14) and matched subjects with similar characteristics and humeral lesions (n = 21) were selected. The following parameters were evaluated: recurrence rate, range of motion, Rowe score, Constant score, and Simple Shoulder Test score (SST).

Results

There were no differences in the characteristics of the two cohorts (age, sex, side, number of previous dislocations or hypermobility). After a minimum follow-up of 4 years (mean = 5.4 years [SD = 1.24 years]) one patient (7.1%) in the remplissage group had a recurrence and 4 patients (19%) in the control group, and one patient had a recurrence of instability (24% showed instability; no significant difference, P = .41). In both groups there were significant improvements in the Rowe, Constant, and SST scores (P < .01), but there were no differences between groups. The residual deficit in external rotation in the remplissage group was 9.29°±16.85°, and in the control group it was 9.62̊ ± 20.0̊ (P > .05).

Conclusion

A remplissage procedure does not affect patient functional outcome or the range of motion. The residual instability rate was 7% in the remplissage group and 24% in the control group.

Evidence level

IIb.

Clinical relevance

The remplissage technique is a safe procedure that might have an effect on the rate of recurrence in patients with anterior shoulder instability and large Hill-Sachs humeral lesions.