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Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability: Current and Evolving Concepts
Simon T Hwang1, Jeffrey L Horinek2, Javier Ardebol1
1Shoulder Surgery, Oregon Shoulder Institute, Medford, Oregon.
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A Hill-Sachs lesion (HSL) is a compression fracture on the posterolateral humeral head that can increase the risk of recurrent shoulder instability after isolated arthroscopic Bankart repair.
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Remplissage involves capsulotenodesis of the infraspinatus tendon and posterior capsule into the HSL to prevent its engagement with the glenoid rim through extra-articular conversion and restraint against humeral head anterior translation.
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The glenoid track concept can be applied preoperatively and intraoperatively to evaluate risk of recurrence and help direct clinical management options for recurrent shoulder instability.
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Recent literature supports expanding indications for remplissage to include patients with on-track HSLs who are at increased risk of recurrence including collision athletes, military personal, and patients with joint hyperlaxity.
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New techniques and suture constructs have demonstrated improved biomechanical strength while avoiding the need to access the subacromial space.
