Remplissage Repair—New Frontiers in the Prevention of Recurrent Shoulder Instability

Abstract

Background: An engaging Hill-Sachs lesion is a defect of the humeral head, large enough to cause locking of the humeral head against the anterior corner of the glenoid rim when the arm is at 90° of abduction and more than 30° of external rotation. Hypothesis: When Bankart lesions are associated with engaging Hill-Sachs defects, simultaneous Bankart repair and remplissage provide lower recurrence rates than does Bankart repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (36 men, 14 women) with combined engaging Hill-Sachs and Bankart lesions were evaluated, before and after arthroscopic management, at a minimum follow-up of 2 years. After imaging and arthroscopic assessment, 25 patients underwent remplissage and Bankart repair, and 25 patients received Bankart repair alone. Patients were evaluated using the UCLA, Constant, and Rowe scores, and range of motion was measured using a goniometer. Postoperatively, all patients underwent magnetic resonance imaging to assess the status of healing of the anterior labrum and whether the tenodesis of the infraspinatus covered the Hill-Sachs defect. Results: At the last appointment, active forward elevation, external rotation beside the body, internal rotation, and all administered scores were significantly improved compared with baseline assessment, with no statistically significant intergroup differences. A new posttraumatic dislocation occurred in 5 patients, all from the Bankart-only group (20%). Conclusion: Remplissage is a safe, relatively short procedure that allows the surgeon to address large humeral defects with a low postoperative recurrence rate. Humeral head large defects predispose to recurrent instability of the shoulder and deserve surgical management.