Remplissage
When combined with arthroscopic Bankart repair, the Remplissage approach has been shown to reduce the frequency of recurrent anterior shoulder instability.
Wolf et al [1] described the surgery in 2007 as an add-on to an arthroscopic anterior stabilisation procedure for the shoulder to address a significant engaging Hill-Sachs defect. When combined with arthroscopic Bankart repair, the Remplissage approach has been shown to reduce the frequency of recurrent anterior shoulder instability.
When the Hill-Sachs lesion is very big and ‘engaged’ the front glenoid with limited overhead movement, this approach is used (i.e.dislocating very easily due to the large Hill-Sachs lesion, as well as the Bankart lesion). In certain cases, a Bankart repair alone might not be enough. As a result, the method of remplissage evolved.
We’ve been doing the Remplissage operation since 2007, and we employ it once the Bankart lesion has been addressed. There are no more incisions (portals) made. The arthroscope is inserted through the anterior portal to examine the Hill-Sachs lesion on the humeral head’s posterior surface. A burr is inserted through the posterior portal to decorticate the Hill-Sachs lesion. Through the posterior portal, a triple-loaded big rotator cuff anchor is placed into the Hill-Sachs defect. Sutures are threaded through the infraspinatus tendon and posterior capsule, then tied down with a ‘parachute approach,’ successfully filling the humeral head defect.
Advantages
The Remplissage approach has the advantage of making the Hill-Sachs defect extra-articular, which eliminates the defect’s interaction with the anterior glenoid rim. It’s suitable for patients with big, engaged Hill-Sachs lesions and soft-tissue Bankart rips who are experiencing instability. These patients have a higher post-surgery failure rate than those with smaller lesions. In this tough subset of traumatic anterior shoulder instability patients, the results of this procedure are much better (10% recurrence rate) than an arthroscopic Bankart repair alone (67% recurrence rate).
