Arthroscopic Hill-Sachs Remplissage

Abstract

Postoperative clinical outcome scores were generally good to excellent following arthroscopic remplissage. No studies indicated a significant loss of shoulder motion following the procedure. The failure rate following Hill-Sachs remplissage compared favorably with previously published rates for patients without clinically important Hill-Sachs lesions who underwent arthroscopic Bankart repair alone. The overall complication rate across the studies was low, further supporting the use of this technique along with Bankart repair in the treatment of glenohumeral instability with a concurrent osseous defect of the humeral head.

BESS/BOA Patient Care Pathways

“…A case-control study comparing arthroscopic stabilization with stabilization and remplissage (total of 50 patients) showed recurrence rates of 20% and 0%, respectively. 46,58 Summary: The management of engaging HillSachs defects remains contentious. Currently, the Latarjet procedure or remplissage in combination with arthroscopic Bankart repair appear the most acceptable methods in treatment but there have been no randomized controlled trials performed to substantiate their use.…”

The Arthroscopic Hill-Sachs Remplissage: A Technique Using a PASTA Repair Kit

“…14 These procedures, however, can be technically challenging, often cannot be accomplished arthroscopically, and are associated with potentially serious complications. 3 In the original technique described by Wolf and colleagues, 4 they placed suture anchors into the humeral head through the Hill-Sachs defect and retrieved one limb of the sutures using a sharp penetrating grasper with a 1-cm bridge of infraspinatus tendon. They repeated this process with another anchor before moving to the subacromial space, retrieving the sutures from the subacromial space, and finally, tying the sutures under direct arthroscopic vision.…”

“…Most notably, complication rates associated with remplissage have been low. 3 The remplissage procedure can be challenging and frustrating for surgeons without prior experience. Problems potentially faced include inadequate visualization, difficulty placing cannulas through the rotator cuff, inaccurate anchor placement, inability to locate the hole through the rotator cuff created by insertion of the awl (if no cannula is used), difficulty retrieving sutures from the subacromial space, inadvertent damage to the sutures while clearing tissue in the subacromial space, and difficulty completing the Bankart repair after the remplissage because of reduced glenohumeral space.…”

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion

“…Their reported loss of motion is greater than many of the other studies that report either no loss of external rotation 15 or less than 2 . 13 Two recent systematic reviews by Buza et al 14 and Leroux et al 16 demonstrated a 2.6 loss in external rotation and no significant loss in external rotation, respectively; the authors concluded clinically that loss of external rotation has not been proven to be an issue after remplissage.…”

“…14,16,18,23 The technique we demonstrate is designed to be simple, effective, and reproducible. Through the percutaneous placement of the 2 suture anchors in the single skin and deltoid incision, the double-pulley technique allows reduction of the posterior cuff tissue into the superior posterior humeral defect for a double reinforced fixation.…”