Hill-Sachs Remplissage Procedure and its Role in Arthroscopic Stabilisation of the Shoulder

Abstract

The arthroscopic Hill-Sachs Remplissage procedure was first described in 2004 and published in 2008. It consists of an arthroscopic posterior capsulodesis combined with an infraspinatus tenodesis to achieve a “filling in” effect of posterior humeral head defects. The technique was put forward as a solution to high rates of Bankart repair failure, in the presence of large Hill-Sachs lesions. We describe the evolution of the technique and its outcomes and report on the evolving surgical indications over the last decade in response to new paradigm shifts. Due to a better understanding of the pathophysiology of shoulder instability, emphasis was given to both Bankart soft tissue repair and to the associated bony injuries, accounting for both glenoid and humeral head (bipolar) bone loss. We present the transition from the concept of “engaging” Hill-Sachs lesions to the concept of “on-track” / “off-track” lesions and the current role of Remplissage in shoulder instability surgery which remains paramount. We believe that in view of the critical role of bipolar bone defects in shoulder instability, preoperative magnetic resonance imaging assessment of the glenoid track of Hill-Sachs lesions is becoming increasingly important in preoperative planning. This allows the orthopaedic surgeon to detect an “off-track” lesion, select the appropriate surgical technique and improve surgical outcomes.