EVIDENCE-BASED REVIEW & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: BANKART REPAIR WITH REMPLISSAGE FOR RECURRENT GLENOHUMERAL INSTABILITY WITH BONE LOSS

Abstract

ABSTRACT Introduction: Recurrent anterior glenohumeral instability with "on-track" Hill-Sachs lesions and subcritical glenoid bone loss remains a therapeutic challenge, with considerable failure rates following isolated arthroscopic Bankart repair (BR). The addition of the Remplissage procedure (BR-R) has been proposed to improve stability and shoulder function, however, its effectiveness in "on-track" lesions remains uncertain. Methods: An evidence-based review was conducted in PubMed, Embase, Cochrane Library, and BVS (search up to August 2025), including comparative clinical studies that evaluated BR-R versus isolated BR in patients with anterior instability, on-track Hill-Sachs lesions, and partial glenoid bone loss. Primary outcomes were recurrence of dislocation and shoulder function; secondary outcomes included residual apprehension, reoperation, and return to sport. Results: Four studies met the inclusion criteria (one systematic review of six cohort studies and three additional cohort studies; 537 patients in total). Across studies, BR-R showed lower recurrence rates (0–7.7% vs. 3.5–30%) and better functional scores (WOSI, SSV, SANE, ASES, ROWE), higher return-to-sport rates at preinjury level in athletes, and less residual apprehension, without clear increase in complications. Overall certainty of evidence was very low. Conclusions: Very low-quality evidence suggests that the addition of Remplissage to arthroscopic Bankart repair may improve stability and functional outcomes compared with isolated Bankart repair in patients with on-track bone loss. Level of evidence II; Systematic review.