Bankart + remplissage | Kemble Wang Orthopaedics

Shoulder adolescent/adult anterior instability with Hill-sach's lesion, post-op from arthroscopic Bankart repair with Remplissage

You or your child has just undergone a shoulder stabilization procedure with Kemble. This means that you/your child had shoulder instability/dislocation, with tears in the labrum, and a 'divot' in the humeral head bone of the shoulder.

The Bankart repair refers to repair of the labral tear, and the Remplissage procedure refers to filling up of the divot with soft tissue (like filling in a pothole on the road). Whilst the Bankart repair is the mainstay of the procedure, Kemble sometimes adds a remplissage to improve stability, especially in young/adolescent patients. The following is a schematic diagram of such a procedure

Postoperatively your arm will be in a sling. You can start coming out of the sling straight away with the physiotherapist for exercises. However, you should remain in the sling for the majority of the time for the first 6 weeks.

Dressing: your shoulder will have several arthroscopic key-hole portal wounds. this will have sutures holding it closed. on top of that there will be a water-resistant dressing. On top of that again there will be some bulky temporary padding held with tape to decrease swelling for the first day or so. This bulky temporary padding should be removed before you are discharged from hospital.

It is normal to have some tingling or numbness or weakness following your procedure. This is often due to a nerve block performed preoperatively to help with your pain. This will wear off in the first day or two.

The following is your physiotherapy prescription:

Physiotherapy Prescription:

Weeks 0-3 postop Sling x 6 weeks
- No Pendulars
- Active, active-assisted ROM in shoulder flexion/extension plane OK
- Full Elbow and wrist ROM OK
- No Shoulder external rotation past 0 degrees
- No shoulder abduction
- Deltoid isometrics OK
Weeks 3-6 postop
- Out of sling altogether
- No Assisted shoulder ER past 0 degrees
- No Forward flexion > 90 degrees
- No Abduction > 90 degrees|
- passive ROM OK
- Pool exercises for AAROM in flex/ex, horizontal Adduction
- OK to start light vertical rows
- Exercises should be narrow grip and in front
- No flies or bench press
- Can do AROM, strength and isometrics
Weeks 6-12 postop
- Continue PT as above
- AROM, AAROM to improve ER
- Goal 10-20 degrees less than other side
- No flies, No bench press
- PRE’s for biceps, triceps, scapula
- No ER PRE’s (progressive resistive exercises)
3 months postop
- AROM aiming for full ROM
- Keep PRE’s below horizontal plane
4 months postop
- Return to sports for non-throwers, non-contact
- Return to non-flight activities for gymnasts
6 Months postop
- Return to all sports