The Remplissage Procedure in Addition to Arthroscopic Stabilization for Non-Engaging Hill Sachs Lesions: A Systematic...

To evaluate the clinical outcomes of patients with on-track or non-engaging Hill-Sachs lesions (HSLs) undergoing Bankart repair (BR) versus BR with adjunctive remplissage (BR-R).

Three databases (MEDLINE, EMBASE, and PubMed) were searched on August 4th, 2025 for studies assessing outcomes following BR and BR-R. Nine studies involving 1006 patients (20.2% female, mean age 24.4 years, mean follow-up 33.5 months, 682 BR, 324 BR-R) were included. Compared with BR-R, the BR group demonstrated higher rates of recurrent instability (16.1% vs. 3.7%; RR = 3.39, 95% CI 1.96-5.89, p < 0.001, I² = 0%), re-dislocation (8.8% vs. 2.8%; RR = 2.36, 95% CI 1.13-4.95, p = 0.02, I² = 0%), and revision (9.4% vs. 2.8%; RR = 2.85, 95% CI 1.20-6.76, p = 0.02, I² = 0%). RTS was higher after BR-R (RB = 1.16, 95% CI 1.06-1.27, p < 0.001, I² = 0%). ROM was greater after BR in one of three studies. WOSI (MD=-1.77, 95% CI -3.54-0.01, p = 0.05, I² = 36%) and ROWE (MD=-4.86, 95% CI -8.09-1.62, p < 0.001, I² = 91%) scores favored BR-R, while ASES, SANE, VAS, and SSV were comparable. Apprehension was more common after BR (26.8% vs. 12.1%; RR = 2.42, 95% CI 1.45-4.04, p < 0.001, I² = 0%), and other complications were similar. Retrospective data suggests BR-R for on-track HSLs is associated with low risk of complications and offers significantly reduced risk of recurrent instability with similar outcomes compared to BR alone. Further research is needed to understand the indications for adjunctive remplissage in the setting of on-track/non-engaging HSLs.