Remplissage Procedure Indications, Techniques, and Outcomes

Abstract

Hill-Sachs lesions are a challenging clinical problem in the context of anterior shoulder instability. Historically, unless very large, these lesions were thought to be less significant than glenoid defects. Recently, more importance has been placed on whether a Hill-Sachs lesion is on-track or offtrack, with off-track lesions predisposing patients to higher risk of postoperative recurrent instability. Given the high risk for recurrent shoulder instability in patients with Hill-Sachs lesions that are off-track, augmentation procedures, such as the remplissage procedure, are often indicated alongside a Bankart repair. The proposed advantages of the remplissage include directly addressing the Hill-Sachs lesion to prevent engagement, the ability to address any associated intraarticular pathologies during the arthroscopy, and to avoid a more invasive open procedure with a higher complication rate. Remplissage has been shown to reduce the recurrence rate compared to those undergoing arthroscopic Bankart repair alone and to have a comparable recurrence rate to the Latarjet procedure in the appropriately selected patient while also having a much lower complication rate than the Latarjet procedure.