The term 'Remplissage' means 'to fill in'.
• 1st described in 2007 by Wolf et al (1) as an adjunct to the arthroscopic anterior stabilisation procedure of the shoulder in order to address a large engaging Hill-
Sach's defect.
•This technique has been reported to be effective in reducing the incidence of recurrent anterior shoulder instability, when used along with arthroscopic Bankart repair .
Indication-
• This technique is performed when the Hill-Sachs lesion is very large and engaging the anterior glenoid with little overhead movement (i.e. dislocating very easily due to the large Hill-Sachs lesion, as well as the Bankart lesion). In these situations a Bankart repair alone may not be sufficient. Thus the development of the remplissage technique.
Operative Technique-
• The arthroscope is placed through the anterior portal to view the Hill-Sach's lesion on the posterior aspect of the
humeral head. Through the posterior portal, a burr is introduced to decorticate the Hill-Sach's lesion.
• A triple-loaded large rotator cuff anchor is inserted into the Hill-Sach's defect through
the posterior portal.
• Sutures are passed through the infraspinatus tendon and the posterior
capsule, which are then tied down with a 'parachute technique', hence successfully filling the defect on the humeral head.
Advantages -
• The ability to make the Hill-Sach's defect
extra-articular, thereby eliminating engagement of the defect with the anterior glenoid rim.
• It is ideally suited to instability patients who have large, engaging Hill-Sachs lesions and soft-tissue Bankart tears. These patients are known to have a higher failure rate after surgery than those with smaller lesions. The results of this technique in this difficult subset of traumatic anterior shoulder instability patients are significantly better (10% recurrence rate) than with an
arthroscopic Bankart repair alone (67% recurrence rate).
