Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy

Abstract

The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization.

Fig 1

Arthroscopic view of the right shoulder through the posterior portal showing a Hill-Sachs lesion and a rotator cable injury of the posterior part. (HH, humeral head.)

Fig 2

(A, B) Arthroscopic view of the right shoulder through the posterior portal showing a Hill-Sachs lesion and insertion of a titanium anchor through the additional posterolateral portal. (HH, humeral head.)

Fig 3

Arthroscopic view of the right shoulder through the posterior portal showing the use of the BirdBeak instrument to attach the posterior part of the rotator cable to create a superior suture through the additional posterolateral portal. (BB, long head of biceps tendon; HH, humeral head.)

Fig 4

(A, B) Arthroscopic view of the right shoulder through the posterior portal showing suture positions after attaching the rotator cable during the remplissage procedure. (HH, humeral head.)

Fig 5

Cadaveric illustration of a left shoulder showing the position of the remplissage sutures inside the joint. The superior suture is white with a black stripe, and the inferior suture is blue. (CS, collum scapulae; CSA, circumflex scapular artery; HH, humeral head; IS, incisura scapulae; JC, joint capsule; PHC, posterior humeral circumflex artery; QL, quadrilateral space; SS, spina scapulae; TL, trilateral space.)

Fig 6

Cadaveric illustration of a left shoulder showing the position of the remplissage sutures in the subacromial space after the removal of the acromion. The superior suture is white with a black stripe, and the inferior suture is blue. (ISP, infraspinatus muscle; PHC, posterior humeral circumflex artery; QL, quadrilateral space; SPA, suprascapular artery; SS, spina scapulae; SSP, supraspinatus muscle; Tmin, teres minor muscle.)