Ultrasound-Assisted Arthroscopic Remplissage

Recurrent anterior shoulder dislocation, especially in cases with an engaging Hill-Sachs lesion, can lead to high recurrence rates following Bankart repair alone. Remplissage, an adjunct technique involving the infraspinatus and teres minor, enhances stability by converting the intra-articular Hill-Sachs lesion into an extra-articular defect. However, it is technically demanding and requires precise anatomical identification. We describe an ultrasound-assisted arthroscopic remplissage technique that enhances procedural accuracy and safety. In this method, ultrasound is used intraoperatively to identify the infraspinatus, teres minor, and the Hill-Sachs lesion. Percutaneous needle placement and anchor insertion are guided under real-time ultrasound visualization. This approach facilitates accurate fixation using the double-pulley technique, ensuring optimal tissue compression and stability. Ultrasound complements conventional arthroscopy by enabling soft tissue visualization, guiding safe portal placement, and improving anchor orientation, especially for less-experienced surgeons. This technique offers a safer and more effective alternative in treating recurrent shoulder instability with engaging Hill-Sachs lesions.