Thank you. On behalf of everyone involved in the research project, I'd like to thank Anna and the meeting organizers for inviting us to speak today. These are disclosures related to support of our research foundation at our clinic. As we all know, isolated arthroscopic bank art repair is at high risk for failure of arthroscopic stabilization in the setting of significant bone defects. With regards to humeral bone loss, there are several treatment options that allow us to directly address the Hill-Sachs defect surgically. Luckily for us as arthroscopists, Dr. Wolfe pioneered the arthroscopic remplissage, a safe and reproducible method to fill the Hill-Sachs defect with soft tissue and render it extra articular. Early literature has shown promising results in favor of remplissage, but currently all studies are lower level 3 and 4 evidence. The authors of a systematic review in last month's Arthroscopy Journal commented that all studies were of very low to low quality, so we set out to perform a prospective comparative study between arthroscopic bank art repair with and without humeral remplissage in patients with anterior shoulder instability and a Hill-Sachs defect. This was a level 1 prospective randomized trial, double-blinded, meaning the patients and study evaluators were both blinded as to the treatment arm. This was performed over two centers in Canada between six fellowship-trained surgeons over a six-year randomization period. Patients were randomized to two groups, bank art repair with or without remplissage. All patients followed the same postoperative rehab protocol and were followed at the same pre- and postoperative study points. Our sample size was calculated to 108 patients split between the two groups, powered to detect a 10% difference in the WOSI score. We included patients 14 years of age or older with confirmed Hill-Sachs lesions on cross-sectional imaging. We excluded patients with greater than mild glenoid bone loss, so our results cannot be extrapolated to patients with significant bipolar defects. Our primary outcome was the WOSI score, and secondary outcomes that we tracked included repeat dislocations, ASES and SST scores, range of motion, posterior shoulder pain, and Hill-Sachs healing on two-year follow-up MRIs. We did randomize 108 participants. Despite our best efforts, six had to be excluded post-randomization, and 14 in total were lost to follow-up. I also have to mention that seven patients, we had hoped to have complete data by this meeting, but seven patients in each group are still pending their final two-year follow-up visit. We expect to have these completed within the next several months to finalize our data. Between the two groups, we noted no difference with regards to sex, age, BMI, and participation in high-risk or contact sports. So what we found with regards to our primary outcome in the WOSI score was a significant improvement in all patients from pre- to post-operatively, however, there were no difference between the two groups at any time point. The ASES and SST scores mirrored the same pattern as the WOSI score. With regards to repeat dislocation, there were three events in the remplissage group and nine events out of 50 in the no-remplissage group. This yielded p-values that approached but did not cross the threshold for significance, so we can only state that there was a strong trend at this time towards lower rates of re-dislocation in the remplissage group. We also find it important to note that our earliest randomized patients are now between seven and eight years post-operatively, and it's not surprising in this young and active patient population that there's been several subsequent dislocations after the two-year study closure. These have not been included in our analysis, but we do find that it indicates that in this population a two-year follow-up is inadequate in order to make concrete conclusions and longer follow-up would be necessary. We found a high rate of infill healing of the defect on two-year MRIs with a majority of our patients having greater than 75% infill. We also noted aside from a slight loss of ER and abduction in the remplissage group at one-year post-op, there was no change to range of motion between the two groups at all other time points, including their last follow-up visit. We found no difference in the rate of posterior shoulder pain or return to sports and recreational activities between the two groups. So in conclusion, when comparing arthroscopic remplissage versus banquet repair alone, we found no difference in patient-reported outcomes such as WOSI and secondary outcomes, found no difference in two-year range of motion measurements, pain, or return to sports. We did find a strong non-significant trend to lower rates of re-dislocation in the remplissage group, but we highlighted the need for longer-term follow-up given the dislocations that occurred after study closure, and we did find a high rate of infill healing of the defect on follow-up MRIs. Thank you.

arthroscopic stabilization

remplissage

bone defects

randomized trial

re-dislocation