Abstract
BACKGROUND: The impact of arthroscopic Bankart repair (ABR) alone vs. ABR with remplissage (ABR + R) on athlete return-to-play rates and number of games played after surgery is poorly understood. The objective of this study was to utilize online sports databases to compare number of games played and return-to-play rates between athletes who underwent ABR vs. ABR + R for "on-track" Hill-Sachs lesions (HSLs). We hypothesized that there would be no difference in relative games played nor return-to-play rates post-operatively between patients undergoing ABR vs. ABR + R.
METHODS: Patients aged 14-40 years with "on-track" HSLs who underwent either ABR or ABR + R between 2007 and 2022 for anterior shoulder instability were retrospectively reviewed. Exclusion criteria included revision surgery, <1-year follow-up, "off-track" HSLs, >20% glenoid bone loss, nonathletes, and missing data in online sports databases. Athletes were queried in online sports databases and games played were recorded the season before and 3 seasons after surgery, if available. The primary outcome was relative change in games played in the seasons after surgery compared to the season before surgery ( R e l a t i v e G a m e s P l a y e d = # G a m e s i n S e a s o n A f t e r S u r g e r y # G a m e s i n S e a s o n B e f o r e S u r g e r y ). Secondary outcomes included recurrent anterior shoulder instability, defined as recurrent dislocation and/or subluxation, and return-to-play.
RESULTS: Eighty-one patients (ABR: 60 | ABR + R: 21) were included in the analysis, with average age of 18 ± 2 years and average follow-up of 6.5 ± 3.7 years (range, 1.0-14.4 years). "Near-track" HSLs (distance-to-dislocation <10 mm) were present in 20% of the ABR group vs. 76% of the ABR + R group (P < .01). Return-to-play rates were similar between groups (ABR: 75% vs. ABR + R: 81%, P = .58). In the first season after surgery, the ABR group had significantly higher relative games played compared to the ABR + R group (ABR: 1.5 ± 1.5; n = 38 | ABR + R: 0.8 ± 0.5; n = 13, P = .02). This difference did not persist in the second and third seasons after surgery (P > .05). In an adjusted Generalized Estimating Equation model, surgical technique was not significantly associated with relative games played after surgery. Rates of recurrent anterior shoulder instability were not statistically different between groups (ABR: 28% (17/60) vs. ABR + R: 10% (2/21), P = .13).
CONCLUSION: Among athletes with "on-track" HSLs, ABR + R resulted in similar long-term game participation and return-to-play rates and compared to isolated ABR alone. Although patients undergoing ABR + R demonstrated fewer relative games played in the first post-operative season, this difference did not persist in subsequent seasons. Remplissage augmentation may therefore have a temporary impact on early post-operative performance without compromising overall return-to-play outcomes.