Arthroscopic All-Inside Remplissage Technique With Knotless Tape Bridge for Hill-Sachs Lesions

Abstract

The arthroscopic remplissage procedure has been described to successfully treat engaging Hill-Sachs lesions and improve shoulder stability. Several variations of this technique have been described, including remplissage with 1 or 2 knotted or knotless anchors, remplissage with double or triple bridging pulleys, and remplissage with or without a subacromial view. However, most techniques use anchors in combination with round sutures. This article describes an all-arthroscopic articular knotless remplissage technique using a strong, flat, double-strand suture tape bridge fixed with 2 small anchors under direct joint visualization and reduction of the capsule and infraspinatus without requiring a subacromial view.

Fig 1

Step-by-step arthroscopic remplissage technique with knotless tape bridge for Hill-Sachs lesions. (A, B) Axial views of Bankart and Hill-Sachs lesions. (B) Introduction of the first anchor. (C, D) Sagittal and axial views. The second anchor is preloaded with both strands of the tape suture. (E) Superior anchor placement. (F-H) Sagittal view, axial view, and schematic representation of both anchors with bridged suture tapes fixing the capsule and infraspinatus into the defect. (A, acromion; B, Bankart lesion; D, deltoid; G, glenoid; H, humeral head; HS, Hill-Sachs lesion; I, infraspinatus; L, long head of biceps; R, remplissage; S, supraspinatus; SC, subscapularis; SL, anchor; Tm, teres minor.)

Fig 2

(A) External view of preoperative setting with patient placed in lateral position with right arm fixed with traction system. (B) Intraoperative external view; the surgeon achieves full visualization of the joint's anterior, inferior and posterior aspects with the scope through the anterosuperolateral portal. .

Fig 3

Arthroscopic views (A-F) and external view (B) of right shoulder with patient in lateral position. (A) A spinal needle is inserted percutaneously through the posterior capsule over the center of the defect. (B) The humeral head defect is debrided with a curette. (C) An arthroscopic retriever improves visualization of punch entry. (D) A half-pipe metallic cannula facilitates anchor insertion. (E) The first anchor is fixed into the socket. (F) The anchor is completely introduced, and both suture tape strands are prepared to be transported to the posterior standard portal, where they are loaded into the second anchor. (G) External view of first anchor through percutaneous accessory posterior portal and arthroscopic retriever through standard posterior portal. (C, curette; G, glenoid; HC, half-pipe cannula; HS, Hill-Sachs lesion; N, spinal needle; P, punch; PC, posterior capsule; R, arthroscopic retriever; SL, anchor.)

Fig 4

Arthroscopic view of right shoulder from anterosuperolateral portal with patient in lateral position. Bankart repair with all-suture anchors, restoring the bumper effect. (CL, capsulolabral complex; G, glenoid; HH, humeral head.)

Fig 5

External views of right shoulder with patient in lateral position. (A, B) Using an arthroscopic tape retriever (R), both tape strands are transported percutaneously over the infraspinatus and under the deltoid muscle to the standard posterior portal. (C, D) Traction of the tape sutures before fixation can demonstrate the filling of the defect under direct visualization from the anterosuperolateral portal (black stars) before placement of the second implant. (SL, anchor.)

Fig 6

Arthroscopic views of right shoulder with the patient in lateral position. (A) The punch is introduced through the standard posterior portal, lateral to the initial joint entry point. (B) The bone socket for the second, superior anchor is created with the punch. (C) A half-pipe metallic cannula facilitates the introduction of the second anchor, preloaded with both strands of the tape suture. (D) Final view with capsule and infraspinatus reduced and fixed into the defect. (CI, capsule and infraspinatus; G, glenoid; HH, humeral head; HS, Hill-Sachs lesion; P, punch; SL, anchor.)

Fig 7

Coronal (A), axial (B), and sagittal (C) views of arthroscopic remplissage technique with knotless tape bridge for Hill-Sachs lesion. (A, acromion; B, Bankart lesion; D, deltoid; G, glenoid; H, humeral head; I, infraspinatus muscle; L, long head of biceps; R, remplissage; S, supraspinatus muscle; SC, subscapularis muscle; Tm, teres minor.)