Abstract:

Background

Anterior shoulder instability （ASI） is a common disease in sports medicine， mainly in young people and athletes， and is usually caused by external forces encountered when the arm is in an extreme abduction and rotation position. The incidence of ASI is 23.9 cases per 100 000 people per year， accounting for 95% of all shoulder dislocations. Due to the contact and compression of the anterior humeral head with the subscapular anterior inferior margin， this injury is usually accompanied by anterior glenolabial and soft tissue injury and posterolateral depression of the humeral head. Hill-Sachs injury occurs in about 67% to 69% of patients in the first dislocation. Hill-Sachs defects increase the risk of laboplasty failure and make patients more prone to re-dislocation，which further leads to structural damage and dysfunction of the glenohumeral joint. In recent years，research has shown that for the first time， dislocation after arthroscopic surgery treatment can significantly reduce the recurrence rate and increase the chances of recovery movement under the arthroscope Bankart repair （arthroscopic Bankart repair， AB）， used to be the gold standard for patients with anterior and inferior labrum tears， Hill-Sachs injuries accounting for less than 20% of the humerus head and no critical bone defect in the anterior pelvis， but studies have shown a high recurrence rate after surgery. Remplissage was first proposed by Conolly et al.， which mainly filled the subincaudal tendon and joint capsule to the Hill-Sachs injury site of the humerus head. Studies have shown that arthroscopic Bankart repair with Remplissage （ABR） combined with AB may reduce the recurrence rate of patients with Hill-Sachs injury， but the benefits of its treatment are still controversial. Surgery such as Remplissage may increase the loss of external rotation Angle after surgery. Meta-analysis can systematically integrate and quantitatively analyze the results of multiple independent studies， improve the statistical efficiency of the study， reduce the contingency and bias of the results of a single study，and help draw more reliable conclusions. Although the efficacy of AB and ABR has been investigated in different studies， results have been inconsistent due to differences in study design， sample size，and outcome measures. Due to the differences in design， outcome indicators， and other aspects of existing studies， meta-analysis helps provide a more accurate and objective effect assessment for AB and ABR treatment of Hill-Sachs injury. It provides more robust evidence to support clinical decisionmaking.

Objective

To evaluate the clinical efficacy of AB combined with ABR in the treatment of shoulder joint forward instability ASI with Hill-Sachs injury by meta-analysis.

Methods

PubMed，Scopus， Embase， Cochrane Library， and Web of Science databases were searched to collect randomized controlled trials， case-control studies， and cohort studies related to AB and ABR treatment of ASI with Hill-Sachs injury. Stata 17.0 was used for statistical analysis.

Results

A total of 18 studies were included， involving 1，515 patients. Compared with AB group， ABR group had significantly lower recurrence rate （OR=0.19， 95% CI：0.12-0.32， P＜0.001）， secondary surgery rate （OR=0.16， 95% CI： 0.07-0.38， P＜0.001）， and complication rate （OR=0.07， 95% CI：0.01-0.49， P=0.007）， and the recovery of motion was better （OR=4.96， 95% CI：1.75-14.03， P=0.003）. However， the two groups had no statistically significant differences in lateral rotation Angle （MD=-6.99， 95% CI： -15.64-1.66， P=0.113）and joint function scores. Sensitivity analysis and publication bias evaluation showed that the results were robust.

Conclusion

ABR was superior to AB in reducing the recurrence rate， secondary operation rate， and complication rate of shoulder forward instability with Hill-Sachs injury， but the difference in postoperative functional recovery was insignificant.

Key words: Anterior shoulder instability, Hill-Sachs lesion, Bankart repair, Remplissage procedure