REMPLISSAGE PROCEDURE

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).