Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

Abstract

Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We present the arthroscopic remplissage technique originally described by Koo and Burkhart et al. with a modification in the percutaneous anchor placement and suture tying that is reproducible and effective. We percutaneously place 2 suture anchors, which require no additional suture passing across the tissue, to create a double pulley technique, filling the defect with posterior capsule and rotator cuff. Therefore, the Hill-Sachs defect becomes extra-articular, eliminating the potential engagement of the anterior glenoid and contribution to recurrence of instability. This technique is applicable broadly for most Hill-Sachs lesions that need addressing. By not having to pass or shuttle any suture through tissue after anchor placement and by eliminating the necessity to go subacromially to retrieve or tie suture, the technique saves time and improves reproducibility. The compression of tissue into the Hill Sachs surface area also is improved by double-reinforced suturing through the double-pulley technique. The combination of these advantages creates a sound and efficient technique for remplissage.

Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy

“…Contrary to most previously described techniques,1, 2, 2, 9, 10 in our study a full remplissage procedure is initially performed using posterior portals with the patient in the beach-chair position. This enables the surgeon to easily review the ROM and movement of the humeral head, as well as to assess for the presence of engagement of the Hill-Sachs defect after the remplissage procedure.…”

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

“…Koo et al revised the procedure with the "double pulley" technique, which allows for the sutures to be tied over the infraspinatus tendon instead of through it [51]. This technique has proven to be successful, but in 2016, Alexander et al [52] further modified the technique. Their technique still utilizes the double pulley technique, but they conducted a percutaneous placement of the two suture anchors in the single skin-and-deltoid incision.…”

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.…”