Clinical Outcomes of Arthroscopic Bankart Repair With Remplissage Versus Bankart Repair With Remplissage and Arthroscopic Subscapularis Augmentation in Recurrent Anterior Shoulder Instability

Background: Recurrent anterior shoulder instability is frequently associated with Hill-Sachs and Bankart lesions, which compromise joint stability. While arthroscopic Bankart repair remains a widely accepted treatment for anterior shoulder instability, combining it with remplissage, with or without anterior subscapularis augmentation (ASA), has been proposed to enhance outcomes in these cases. Purpose: To compare the clinical and functional outcomes of arthroscopic Bankart repair with remplissage, with or without ASA, in patients with recurrent anterior shoulder instability and subcritical glenoid bone loss (GBL) (<15%). Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study analyzed 56 patients with recurrent anterior shoulder instability who underwent surgery at a single tertiary university hospital between 2018 and 2022. Patients were grouped into 2 categories based on the surgical approach: Bankart repair with remplissage (group A) and Bankart repair with both remplissage and ASA (group B). Functional outcomes were evaluated using the Rowe score and the modified Constant-Murley (CM) score, while external rotation (ER) deficits were measured in adduction (ER1) and at 90° abduction (ER2). In addition, recurrence rates and postoperative clinical scores were systematically analyzed to assess the efficacy of these techniques. Results: The recurrence rates were 5.1% in group A and 0% in group B. Both groups demonstrated significant postoperative improvements in clinical outcomes. In group A, the mean Rowe score improved from 37.8 ± 4.5 to 93.1 ± 5.3 and the CM score from 69.8 ± 7.2 to 96.5 ± 2.5 ( P < .0001). In group B, the Rowe score increased from 37.5 ± 6.4 to 94.7 ± 1.2 and the CM score from 71.2 ± 8.3 to 95.4 ± 0.9 ( P < .0001). No statistically significant differences were observed between groups in postoperative Rowe ( P = .23) or CM scores ( P = .08). However, when postoperative range of motion was analyzed, the addition of ASA was associated with greater ER deficits compared with remplissage, both in ER1 (−12.5°± 9.19° vs −18.33°± 2.46°; P = .013) and ER2 (−14.2°± 7.67° vs −18.83°± 1.94°; P = .017). Conclusion: This study demonstrates that adding ASA to arthroscopic Bankart repair with remplissage significantly reduces ER while maintaining excellent clinical outcomes and low recurrence rates. The combination of these techniques provides a viable option for managing recurrent anterior instability, particularly in cases with poor tissue quality and GBL <15%.