Arthroscopic Anterior Labral Repair with Concurrent Remplissage

Shoulder instability is a complex problem, particularly in the setting of concomitant subcritical bone loss, which may increase patients' risk of recurrent dislocation. Although bony augmentation may be successful for patients with critical bone loss, those with subcritical bone loss may benefit from arthroscopic labral repair and remplissage.

Indications for arthroscopic stabilization and remplissage include (1) off-track or engaging Hill-Sachs lesions with subcritical bone loss, which often measure between 20% to 40% in volume; (2) failed previous arthroscopic repair without bone loss; and (3) collision or contact athletes with smaller, on-track Hill-Sachs lesions that are at higher risk for recurrence.

The patient is placed in the lateral decubitus position, with the arm in a pneumatic arm holder to assist with traction. Examination under anesthesia is performed. The Hill-Sachs lesion on the posterolateral humeral head is visualized, and the bony bed is prepared for healing. Traction is removed during the remplissage suture passage and final tightening. Two knotless anchors are placed through the infraspinatus and into the defect through the same cannula. The repair stitches from each anchor are shuttled through the opposing anchor's shuttling stitch, which creates a double mattress, staple-like configuration. The remplissage is not tightened until the end of the case to limit closing down the shoulder volume. The labral repair is performed then in standard fashion, utilizing knotless anchors and advancing capsulolabral tissue. The capsulolabral repair is retensioned with each new anchor. Once the labral repair is complete, traction is relieved, and the remplissage is finally tightened.

Outcomes after labral repair with concomitant remplissage are similar to labral repair alone, but with lower rates of dislocation. Current data demonstrate a similar range of motion, including external rotation, with additive remplissage.

Arthroscopic anterior labral repair with remplissage is a useful technique for patients at high risk for dislocation, whether due to anatomic or patient-specific factors. Current postoperative outcomes are similar to labral repair alone, with lower rates of dislocation without loss of motion.

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