Arthroscopy-Assisted Percutaneous Hill-Sachs Remplissage Repair

Arthroscopic remplissage repair of the Hill-Sachs defect has been advocated for engaging or off-track presentation in recurrent shoulder instability. The various described techniques use specialized instruments to pass sutures across the tendon or deploy multiple anchors directly through the infraspinatus tendon and capsule to avoid suture-passing instruments. With either of these methods, pitfalls include a larger-than-required rent in the tissue compromising the tendon quality, along with technical challenges of placing the anchors, deltoid entrapment, the need for accessory portals, and the risk of suture off-loading compromising the repair. In our technique, by viewing from the anterosuperior portal, the sutures from the Hill-Sachs anchor are passed through the infraspinatus tendon by a percutaneously placed spinal needle outside the posterior portal. Finally, all the passed threads are retrieved outside the infraspinatus tendon and capsule in the subacromial space through the posterior portal using an arthroscopic shoulder retriever, thereby avoiding accessory portals and allowing the placement of knots without deltoid entrapment. The percutaneous access allows a better trajectory and precise penetration of the infraspinatus tendon and posterior capsule without creating a rent. This technique is safe, replicable, and cost-effective by avoiding the risk of suture off-loading from the anchor and the need for additional anchors and devices.