In this Technical Note, we describe an arthroscopic remplissage procedure to treat anterior instability. Specifically, we use a technique to perform double-pulley capsulotenodesis of the infraspinatus tendon using a Knotless SutureTak Suture Anchor (Arthrex, Naples, FL). This is a modification of a previously described double-pulley technique. The primary advantage of our technique compared with the previous double-pulley techniques described is that knot tying is not required.

Shoulder instability is often associated with an impaction fracture of the humeral head, commonly referred to as a "Hill-Sachs lesion." This lesion is present in both anterior and posterior instability. Forty percent to 90% of anterior shoulder dislocations have associated Hill-Sachs lesions, whereas 29% to 86% of posterior shoulder dislocations have reverse Hill-Sachs lesions. Both of these lesions can contribute to recurrent instability of the shoulder and require surgery to be treated. Currently, the most common procedures to address Hill-Sachs lesions are the remplissage procedure (transfer of the infraspinatus into the posterior humeral head defect), capsular shift, disimpaction technique, humeral head resurfacing, bone block transfer, or shoulder arthroplasty. Reverse Hill-Sachs lesions are managed with similar procedures, such as the remplissage-equivalent technique described by McLaughlin, which involves transfer of the subscapularis tendon to fill the humeral head defect. The procedure has the advantage of "exteriorizing" the humeral head defect, but in the case of large lesions, it can result in significant loss of the articulating articular surface. The purpose of this article is to describe an arthroscopically assisted disimpaction technique with supplemental grafting using a balloon osteoplasty technique for a reverse Hill-Sachs lesion with bone cement to support and maintain the reduction.

Metastases can occur as part of the natural progression of a variety of malignancies and their mode of spread, manner of presentation, and prognosis are as variable as their primary sources. The ultimate goal of musculoskeletal treatment of skeletal metastases is to get the patient in question back to his or her previous level of function as soon as possible. Skeletal metastases are seldom life threatening and their treatment will rarely render someone cured of their primary disease. Nevertheless, involvement of a musculoskeletal specialist as a part of the multidisciplinary approach can and very often does provide significant improvement in patients' qualities of life. The purpose of this chapter is to discuss the evaluation of a patient with suspected metastatic disease involving the musculoskeletal system and their pre-, intra-, and post surgical management as part of a multidisciplinary team.