This is medium-term follow-up (mean 4 years) of a double-blinded RCT comparing arthroscopic Bankart repair alone versus Bankart repair plus remplissage. Patients had recurrent traumatic anterior instability with an engaging Hill-Sachs lesion and subcritical glenoid bone loss (<15%). The question: does the early anti-recurrence benefit of remplissage hold up over time?
For traumatic recurrent anterior instability with an engaging Hill-Sachs lesion and glenoid bone loss under 15%, add remplissage to your Bankart repair rather than doing Bankart alone. This is Level 1 evidence, and the benefit is durable: redislocation dropped from 22% to 8% at a mean 4 years, and overall instability from 30% to 10%.
The effect is strongest in the patients who scare you most: large Hill-Sachs lesions and contact athletes. In contact athletes, failure fell from 30% to about 5%.
The practical decision framework: subcritical glenoid bone loss plus an engaging or off-track Hill-Sachs favors soft-tissue Bankart with remplissage, which carries far fewer complications (~2% here vs 6-7% for Latarjet). Reserve Latarjet for revision or for severe glenoid bone loss.
Remember why it works: filling the defect makes it extra-articular and adds a posterior restraint, unloading the anterior repair. The threshold at which to abandon remplissage for a bone block remains debated.
This is medium-term follow-up (mean 4 years) of a double-blinded RCT comparing arthroscopic Bankart repair alone versus Bankart repair plus remplissage. Patients had recurrent traumatic anterior instability with an engaging Hill-Sachs lesion and subcritical glenoid bone loss (<15%). The question: does the early anti-recurrence benefit of remplissage hold up over time?
For traumatic recurrent anterior instability with an engaging Hill-Sachs lesion and glenoid bone loss under 15%, add remplissage to your Bankart repair rather than doing Bankart alone. This is Level 1 evidence, and the benefit is durable: redislocation dropped from 22% to 8% at a mean 4 years, and overall instability from 30% to 10%.
The effect is strongest in the patients who scare you most: large Hill-Sachs lesions and contact athletes. In contact athletes, failure fell from 30% to about 5%.
The practical decision framework: subcritical glenoid bone loss plus an engaging or off-track Hill-Sachs favors soft-tissue Bankart with remplissage, which carries far fewer complications (~2% here vs 6-7% for Latarjet). Reserve Latarjet for revision or for severe glenoid bone loss.
Remember why it works: filling the defect makes it extra-articular and adds a posterior restraint, unloading the anterior repair. The threshold at which to abandon remplissage for a bone block remains debated.