I am a physical therapist at a large specialty orthopedic hospital. Two of our surgeons recently went to Europe where they learned how to do a new procedure called Remplissage. They will be doing this surgery on some of our athletes with dual Bankart and Hill-Sachs injuries. My job is to come up with an appropriate rehab program. The surgeons will meet with us next week to review what we recommend. What do YOU recommend?
We read the results of the first study using the Remplissage procedure (combined with a Bankart repair) and comparing it to doing the Bankart procedure alone. The initial results are very impressive with a zero per cent rate of recurrent shoulder dislocations in the Remplissage/Bankart group compared with a 20 per cent rate for the Bankart repair without Remplissage.
The authors do mention that it was a small study of 50 patients (25 athletes in each group) and under the care of only two surgeons. So further studies (like yours) will be very helpful in determing results and any disadvantages to this approach.
Their recommended postoperative rehabilitative approach did include close supervision by the physical therapist. Capsular stretching exercises were allowed on the first day after surgery. The therapists must keep in mind that too much stretch, too soon, with too much force can undo the surgical repair. But without appropriate motion, the patient could end up with a signicant loss (or tightness) of external rotation. Throwing athletes need this motion in order to return to their preinjury level of play.
Twice a week supervision of an exercise program that is then carried out at home daily is advised for the first two weeks. Regular weekly follow-up visits can then be done for the next two months following a traditional rehab program used for Bankart repairs.
It's always a good idea to observe orthopedic surgeries in order to fully appreciate the damage present at the time of surgery, as well as changes in anatomy as a result of the surgery and potential for change in biomechanics. A visual appreciation for the surgical repair and understanding the surgeon's concerns along with the surgeon's precautions and goals for the treatment is usually very helpful in developing an appropriate rehab program for each individual patient.
Francesco Franceschi, MD, et al. Remplissage Repair -- New Frontiers in the Prevention of Recurrent Shoulder Instability. A 2-Year Follow-up Comparative Study. In The American Journal of Sports Medicine. November 2012. Vol. 40. No. 11. Pp. 2462-2469.
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