Study Summary

102 patients with recurrent traumatic anterior shoulder instability and engaging Hill-Sachs lesions (HSL) were randomized to undergo arthroscopic Bankart repair (ABR) with remplissage (REMP) or isolated arthroscopic Bankart repair (NO REMP). 95 patients with available preoperative MRI or CT imaging were included in the secondary analysis. The primary outcome of interest was postoperative recurrent instability, defined as at least one redislocation episode or two subluxation events occurring at least 12 weeks after surgery. Secondary outcomes included Western Ontario Shoulder Instability (WOSI) scores, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) scores, and postoperative shoulder range of motion (ROM). Outcomes were assessed through a 24-month follow-up period with recurrent instability reassessed at approximately 4 years postoperatively. Overall, the results of the study revealed that REMP significantly reduced recurrent instability in patients with inferiorly extended Hill-Sachs lesions characterized by a lower-edge angle (LEA) greater than 90°, while no significant benefit was observed in patients with smaller inferior extensions. These findings suggest that REMP may be particularly beneficial in patients with critical inferior craniocaudal Hill-Sachs extension (IC-HSE).