Remplissage when Bankart is not enough!

Background: Glenohumeral instability frequently involves bipolar bone loss, specifically anterior glenoid rim deficiency and Hill-Sachs lesions (HSL). While arthroscopic Bankart repair addresses soft tissue injuries, failure rates reach 67% to 89% in the presence of significant osseous defects. The "glenoid track" concept identifies "off-track" HSL as a primary risk factor for recurrent engagement and dislocation, necessitating surgical techniques that address the humeral defect.

Objective: This article reviews the rationale, surgical technique, and clinical outcomes of arthroscopic remplissage as an adjunct to Bankart repair for managing engaging Hill-Sachs lesions.

Key Points: Remplissage involves the arthroscopic fixation of the infraspinatus tendon and posterior capsule into the humeral defect using suture anchors. This procedure converts an intra-articular compression fracture into an extra-articular structure, preventing engagement with the anterior glenoid rim. Clinical data indicate that combining remplissage with Bankart repair reduces recurrence rates to approximately 5.4%, compared to 4% to 18% for isolated Bankart repair. Technical variations include anchor placement within the defect valley versus the subchondral rim. While the procedure is minimally invasive with a low complication rate (0.6%), potential side effects include a mean reduction in external rotation ranging from 2.6° to 11.3° and transient posterosuperior pain.

Conclusion: Arthroscopic remplissage is an effective, low-morbidity technique for stabilizing the shoulder in patients with engaging Hill-Sachs lesions. It serves as a reliable alternative to more invasive open procedures, though its impact on terminal external rotation warrants consideration in overhead athletes.