All-Inside Knotless Remplissage Technique

Abstract

Remplissage decreases the risk of recurrence after arthroscopic stabilization for recurrent anterior instability. Traditionally, the procedure requires accessing the subacromial space, which adds time and morbidity to the procedure. This Technical Note describes an all-inside technique for knotless remplissage with 2 interconnected anchors. By avoiding knot tying or accessing the subacromial space, the efficiency of the procedure is improved.

Anterior Shoulder Stabilization Using Single Needle-Assisted Outside-In Remplissage Technique and Bankart Repair

“… 21 Further, Callegari et al. 22 described an all-inside technique for knotless remplissage with 2 interconnected anchors; by avoiding knot tying or accessing the subacromial space, the efficiency of the procedure was effectively improved. In future research, it is still worth exploring about how to simplify the steps of the procedure, as well as creating more convenient tools to facilitate the surgical process.…”

Knotless Arthroscopic Glenoid Labral Stabilization for a 270° Tear With Concurrent Remplissage in the Lateral Decubitus Position

“… 28 As such, remplissage has emerged as an effective strategy to prevent recurrent instability after arthroscopic shoulder stabilization procedures. 29 …”

“…With regard to the remplissage technique, early descriptions of the procedure involved the use of tying knots to link 2 anchors together via a broad mattress configuration. 29 , 31 More recently, knotless anchors have been applied to remplissage procedures, obviating the need to do an extensive subdeltoid dissection to tie arthroscopic knots. 32 The repair ends of the knotless mechanism are passed into the other anchor, respectively, and a suture staple is created with excellent fixation and compression.…”

Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability

“…They reported a statistically significant increase in clinical load to failure in the knotless construct (788 ± 162) compared with the traditional knotted construct (488 ± 227 N; p = 0.003) 54 . Subsequent authors have also described techniques for avoiding the need to access the subacromial space which have facilitated the ease of the procedure 50,53 . Although these variations in technique provide unique advantages in procedural efficiency and fixation strength, the effects on long-term clinical and functional outcomes have yet to be determined.…”

“…This technique uses 2 suture anchors which are placed in the HSL and tied together in the subacromial space, creating a broad mattress configuration which reduces the rotator cuff tendon into the HSL 52 . More recent methods have suggested the use of interconnected knotless anchors without the need to access the subacromial space, in an attempt to minimize the risk of knot failure and reduce technical difficulty and surgical time by avoiding the need to access the subacromial space 53 . A biomechanical study performed by Funakoshi et al 54 compared a knotless construct with a traditional knotted double mattress construct for remplissage and found greater biomechanical strength with the knotless suture construct.…”