Improved Outcomes and Low Rate of Medical Discharge at a Minimum 10-Year Follow-Up After Arthroscopic Bankart Repair With Remplissage for "Off-Track" Engaging Hill-Sachs Lesions With Subcritical Glenoid Bone Loss in Active-Duty Servicemembers.

PURPOSE: To evaluate long-term outcomes after arthroscopic Bankart repair with remplissage among active-duty servicemembers under 45 years old with engaging Hill-Sachs lesions (HSLs) and subcritical glenoid bone loss (GBL).

METHODS: A retrospective review of prospectively collected data involving consecutive active-duty servicemembers who underwent arthroscopic Bankart repair with remplissage for anterior instability with "off-track" HSL and GBL <13.5% between January 2010 and September 2015 with a minimum 10-year follow-up was performed. Patient-reported outcome measures (PROMs) included the pain visual analog scale, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, and Rowe Instability score. Rates of return to duty and subjective return to sport at the prior level were collected. Minimal clinically important difference thresholds were calculated using a distribution method.

RESULTS: Final analysis included 22 patients (age: 25.8 ± 5.8, 86.4% men) with minimum 10 years (mean: 11.7 ± 1.5, range: 10.0-15.3) of follow-up. From preoperative imaging, the mean GBL was 5.8% ± 1.3% (range: 4.1%-8.4%). From intraoperative measurements, the mean HSL width was 12.7 ± 1.3 mm, depth 8.3 ± 2.1 mm, and size 106.0 ± 30.8 mm2. At final follow-up, PROMs improved (visual analog scale: 7.65-1.6, American Shoulder and Elbow Surgeons: 40.3-88.2, Single Assessment Numeric Evaluation: 48.6-90.0, and Rowe: 39.0-88.6, P < .0001), with sustained PROMs between mid- and long-term time points. The minimal clinically important difference was achieved by most patients (76.2%-95.2%). Two patients (9.0%) experienced complications: 1 with recurrent instability prompting Latarjet (4.5%) and 1 with postoperative stiffness (4.5%). At final follow-up, return to duty was achieved by 86.4% (n = 19) and to preinjury level of sport by 90.9% (n = 20). Three patients underwent medical discharge from the military because of the operative shoulder (13.6%).

CONCLUSIONS: At a minimum 10-year follow-up after arthroscopic Bankart repair with remplissage for off-track HSL with subcritical GBL, active-duty servicemembers showed sustained improvements in PROMs, low rates of recurrent instability, and relatively high rates of return to active-duty and sport, supporting the durability of this procedure in a high shoulder demand population.

LEVEL OF EVIDENCE: Level IV, retrospective case series.