Remplissage Technique Research Articles

Inlay Dynamic Anterior Stabilization With the Long Head of the Biceps Tendon and Remplissage Procedure for Patients With Subcritical Glenoid Bone Loss and On-Track Hill-Sachs Lesion

Augmented Bankart with dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHBT) aims to address anteroinferior glenohumeral instability but does not specifically target Hill-Sachs lesions. The remplissage technique, “filling” the Hill-Sachs lesion, is popular for off-track lesions. The proposed combined approach seeks to stabilize the humeral head without sacrificing the coracoid, making it suitable for high-risk patients prone to recurrent shoulder instability, such as patients with subcritical glenoid bone loss. The operative technique includes patient preparation, creation of arthroscopic portals, confirmation of glenoid bone loss and other injuries, LHBT preparation and tenodesis to the anterior glenoid, and completion of the remplissage procedure. Postoperative protocols involve wearing a sling, self-mobilization, and gradual return to sports. The method aims to improve stability and outcomes in patients with complex shoulder instability issues. The DAS and remplissage is a rational choice for high-demand patients with subcritical glenoid bone loss and on-track Hill-Sachs lesions because it may provide better stability than isolated Bankart repair or Bankart plus remplissage procedures.

Blind-Tie Remplissage: Technique and Sequence

Patients with recurrent anterior shoulder instability and an associated Hill-Sachs lesion are commonly encountered by orthopaedic surgeons. Effective management of the Hill-Sachs lesion can be performed using an arthroscopic remplissage technique to fill the bony defect with the infraspinatus and posterior capsule. Various surgical techniques, anchor configurations, and tying mechanisms can be used to accomplish the remplissage procedure. The goal of this Technical Note is to describe our technique and sequence for accomplishing an arthroscopic “blind-tie” remplissage procedure. In this remplissage technique, the suture anchor sutures placed into the Hill-Sachs defect are tied in a blind fashion over the infraspinatus fascia without direct visualization from within the subacromial space.

Arthroscopic Remplissage Using a Double-Pulley Technique

Background: Anterior shoulder instability is associated with Hill-Sachs lesions (HSLs) in 40% to 90% of cases. When addressing anterior shoulder instability, unaddressed engaging or “off-track” HSL have a recurrence rate of 75%. Remplissage is a known technique to address recurrent instability in the setting of an engaging HSL. In this video, we demonstrate that a double-anchor-pulley technique may be used to address recurrent instability in the setting of engaging HSL. Indications: Patients with recurrent anterior shoulder instability with off-track HSL in patients with glenoid bone loss <20% are candidates for arthroscopic Remplissage. Technique Description: Patients are placed in the lateral decubitus position. Examination under anesthesia is performed to assess for degree of instability and engagement of HSL. Posterior, anterosuperior, and anteroinferior portals are established. Routine diagnostic arthroscopy is performed with identification of the HSL. While viewing from an anterosuperior portal and working through the posterior portal, the HSL bed is prepared with curettage and a bur. A 5.5-mm accessory Cannula is used through an accessory posterior portal. Two knotless all-suture self-tensioning anchors are placed in the anterior and inferior aspect of the defect, passed through the cannula, and tagged for later identification. Bankart stabilization is performed. The knotless anchors are linked to each other to perform a knotless repair with a broad area of compression. Results: Results are excellent with only a 5.6% failure rate, significant patient improvement, low complication rate, and 95.5% return to play. Discussion: We demonstrate the technical aspects of an all-arthroscopic Remplissage technique using all-suture knotless anchors to provide a simple and reproducible method of performing a Remplissage. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Arthroscopic All-Inside Remplissage Technique With Knotless Tape Bridge for Hill-Sachs Lesions

The arthroscopic remplissage procedure has been described to successfully treat engaging Hill-Sachs lesions and improve shoulder stability. Several variations of this technique have been described, including remplissage with 1 or 2 knotted or knotless anchors, remplissage with double or triple bridging pulleys, and remplissage with or without a subacromial view. However, most techniques use anchors in combination with round sutures. This article describes an all-arthroscopic articular knotless remplissage technique using a strong, flat, double-strand suture tape bridge fixed with 2 small anchors under direct joint visualization and reduction of the capsule and infraspinatus without requiring a subacromial view.

The Remplissage Technique for Hill–Sachs Lesions in Competitive Athletes: A Narrative Review

Anterior shoulder instability with Bankart lesion and associated posterior humeral head injury (Hill–Sachs) is common in athletes. Several treatments have been proposed for the management of the Hill–Sachs lesion, from bone grafts or rotation osteotomies to capsulotendinous interposition, such as remplissage. This procedure has been shown to be safe and effective in increasing glenohumeral stability. However, the correct indication concerning the bone defect and its effects in terms of range of motion and function, especially in highly demanding patients, is still debated. This narrative review aims to present the current state-of-the-art of the posterior capsulotenodesis in association with Bankart repair, for treating anterior shoulder instability in competitive athletes.

Mid-term results of arthroscopic Bankart repair and remplissage for recurrent anterior shoulder instability in patients with a history of seizures

BackgroundSeizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures.MethodsIn this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score.ResultsThe mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5).ConclusionIn patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.

Comparison of Interface Pressure, Contact Surface Area, and Percent Area of Coverage Between Two Suture Configurations for Hill-Sachs Remplissage

Purpose: To compare maximum contact pressure, contact surface area, and the percent area of coverage of the bone-tendon interface in the remplissage procedure between two different suture configurations (independent mattress versus double-pulley). Methods: A sample size of seven specimens per group was defined by a 96% power analysis. Hill-Sachs lesions were created in all fourteen ex vivo ovine shoulders, corresponding to a 30% defect of the axial diameter of the humeral head (significant lesion according to literature). The defects were repaired using the remplissage technique applying one of the two randomly chosen suture configurations: two independent mattress sutures or a double-pulley. The contact pressure and contact surface area, as well as percent defect coverage, were recorded using a film sensitive to these parameters. Independent nonparametric tests (Mann-Whitney) were used for the statistical analysis. Results: The double-pulley group exhibited an average pressure of 0.128 ± 0.018 mPa, the contact surface of 0.199 ± 0.044 cm2, and 41.97 ± 9.8% defect coverage. The independent mattress group showed an average pressure of 0.102 ± 0.01 mPa, the contact surface of 0.081 ± 0.041 cm2, and defect coverage of 15.6 ± 8.1%. All three parameters were statistically superior in the double-pulley group (p=0.038, p=0.008, and p=0.008, respectively) Conclusion: The remplissage technique using the double-pulley configuration, presented superior biomechanical characteristics, in terms of contact pressure, contact area, and percent coverage of the defect, compared to the simple independent mattress configuration.

Treatment of Chronic Anterior Shoulder Dislocation by Coracoid Osteotomy with or without Bristow–Latarjet Procedure

ObjectiveTo investigate the clinical efficacy and outcomes of the coracoid osteotomy with or without Bristow–Latarjet procedures in the treatment of chronic anterior shoulder dislocation (CASD).MethodsBetween January 2013 and January 2019, 20 shoulders of 18 patients who were diagnosed with chronic anterior dislocation and underwent open reduction in our trauma center were retrospectively studied. Open coracoid osteotomy with Bristow–Latarjet procedures were performed on 16 shoulders and open coracoid osteotomy without Bristow–Latarjet procedures were performed on four shoulders. Open coracoid osteotomy with or without Bristow–Latarjet procedures were chosen on the basis of the stability of the shoulder after reduction. Outcomes were assessed preoperatively and postoperatively with the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder rating scale, and the range of motion (ROM) for shoulder activity.ResultsThere were three males and 15 females with an average age of 60.94 ± 2.69 years. The time between dislocation and treatment ranged from 21 to 240 days with an average of 73.3 ± 14.4 days. All patients were available for a mean follow‐up of 15.2 ± 4.3 months. No procedure‐related death or incision‐related superficial or deep tissue infection was identified in all cases. No iatrogenic neurovascular injuries or fractures were found in this study. At the time of 12 months follow‐up, the range of motion and the shoulder functional evaluation (VAS [P < 0.001], ASES [P < 0.001], and UCLA score [P < 0.001]) in patients who underwent Bristow–Latarjet procedures were significantly improved. Subluxation after surgical procedure was found and confirmed in one patient and this patient refused to undergo revision surgery. According to the Samilson and Prieto classification system, 16 shoulders were assessed as grade 0, three shoulders were grade 1, one shoulder was grade 2.ConclusionsCoracoid osteotomy with or without Bristow–Latarjet procedure yielded an acceptable clinical result in this study. This method has the advantages of enlarging the exposure of surgical field, assisting reduction of shoulder, and convenient conversion to Bristow–Latarjet procedure. It is an efficient and reliable method for treatment of chronic anterior shoulder dislocation.A 69‐year‐old woman diagnosed with right chronic anterior shoulder dislocation with large Hill–Sachs lesion. The latarjet procedure with remplissage technique was applied for this patient.

Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage

Background: No study has reported clinical evidence for cartilage change in the glenohumeral joint or the cause of loss in range of motion (ROM) after arthroscopic Bankart repair with remplissage technique (BR). Purpose: To investigate the postoperative features of glenohumeral joint cartilage, ROM, and anchor placement for remplissage at a minimum of 2 years of follow-up after BR and to analyze the correlations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 21 patients who underwent BR received follow-up for a minimum of 2 years. At both preoperative assessment and final follow-up, passive shoulder ROM, Oxford Shoulder Instability Score, Simple Shoulder Test score, and Single Assessment Numerical Evaluation score were assessed. All patients underwent 3.0-T magnetic resonance imaging (MRI) examination at final follow-up. The clinical outcomes, glenohumeral cartilage or Hill-Sachs lesion–related MRI parameters, and their potential correlations were analyzed. Results: The mean follow-up was 55.0 months (range, 24-119 months). Compared with preoperative assessment, all functional scores significantly improved (P < .001). At the final follow-up, a significant ROM loss (>15°) of external rotation (ER) at the side (ER0) was found in 12 patients, among whom 8 patients had significant ROM loss of ER at 90° of abduction as well. Further, 12 patients with decreased ER had significantly higher signal intensity of cartilage on the anterior, middle, and posterior humeral head (anterior, P = .002; middle, P < .001; posterior, P < .001) than 9 patients with normal ER. The ratio of the width of the remplissage anchor to the diameter of the humeral head (w:d ratio) was significantly greater (P = .031) in the decreased ER group than in the normal ER group. Correlation analysis showed that signal intensity on the posterior humeral head and ER0 loss (ΔER0) had a significantly positive correlation (r = 0.516; P = .034), while the w:d ratio and ΔER0 had a significantly positive correlation (r = 0.519; P = .039). Conclusion: At a minimum of 2 years of follow-up, patients who underwent BR showed significant clinical improvement compared with preoperative assessment, except for limitations in ER. The glenohumeral cartilage degeneration (higher signal intensity) after BR had a significantly positive correlation with the postoperative ER loss, which was found to be associated with a relatively medial placement of the remplissage anchor.

Clinical and functional outcomes of the remplissage technique to repair anterior shoulder dislocation: average 7years of follow-up.

The purpose of this work is to report mid- to long-term clinical results, recurrence rates and instability following surgery to repair anterior dislocation of the shoulder by the remplissage technique. This was a retrospective case series at a single center with patients with anterior shoulder instability that received surgery using the remplissage technique. Rowe questionnaire, instability complaints, recurrence episodes and return to sport were analyzed. Of all patients screened, 21 (92.3%) were enrolled and only 2 patients were lost to follow-up. The mean age of the patients at the time of surgery was 27.8y.o., and the mean number of dislocations before surgery was 3.2 episodes. The follow-up average was 83.8months (range 28-126). No case of postoperative infection was observed. Two patients (9.5%) had recurrent shoulder instability and required reintervention after 18 and 48months. The average final Rowe score was 92.9 (range 75-100). All patients that played sports before surgery returned to the sport, and 73.7% of them returned to the same activity level. The remplissage technique applied to repair anterior shoulder dislocation with humeral bone loss presents good results regarding clinical scores, shoulder stability and acceptable rates of return to sports, even in a mid- to long-term follow-up. IV.

Simultaneous Acetabular Labrum Reconstruction and Remplissage of the Femoral Head–Neck Junction

With the recent increase in the use of hip arthroscopy, revision hip arthroscopy also has become more prevalent; nevertheless, it is often complex, and many factors should be considered to achieve a satisfactory clinical outcome. Labral reconstruction or augmentation technique is used in cases of severely deficient acetabular labral tissue to restore the fluid seal mechanism. In cases of previous over-resection of cam impingement, the remplissage technique, used to restore the bony defect of the femoral head–neck junction and preserve the joint seal, is an established technique that has been recently reported in the hip with the use of iliotibial band with the same aim as in the shoulder, filling in of the defect due to healing of the soft tissue to the underlying bony impression. We aim to describe a labrum reconstruction in combination with a remplissage of the femoral head–neck junction with a dermal graft in a patient with recurrent hip pain after hip scope. This combination may improve hip stability and reduced pain after failed hip scope.

Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy

The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization.

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability

Hill-Sachs lesions of the humeral head are associated with recurrent anterior shoulder instability. Arthroscopic double-pulley remplissage has emerged as the leading alternative to the open Latarjet procedure to address recurrent shoulder instability with comparable recurrence rates and favorable complication rates. This Technical Note describes our adaptation of the double-pulley remplissage technique by using 2 portals, with the anterior portal used as the viewing portal and suture passage through the posterior portal. This technique eliminates the need for a lateral percutaneous portal, consequently minimizing operative time and postoperative morbidity. Furthermore, using the anterior portal as the viewing portal allows for direct visualization of the reduction of the infraspinatus into the Hill-Sachs defect. The drawback of this technique is that there is no view of the subacromial space during knot tying.

The dual subscapularis procedure: a modified Hawkins' technique for neglected posterior fracture/dislocation of the shoulder.

Posterior fracture/dislocation of the shoulder is a rare injury that is frequently missed on initial assessment. It is frequently associated with reverse Hill-Sachs impression fracture. Several orthopaedics procedures have been described on the literature for reconstructable reverse Hill-Sachs lesion. The McLaughlin's procedure and its modifications, anatomic bone grafting procedures, rotational osteotomies, and the remplissage technique were reported by many authors. We advocated a new "dual subscapularis procedure" that consists of the Hawkins lesser tuberosity transfer with addition of filling the remainder of the defect with a part of subscapularis tendon. In the period between January 2013 to December 2017, 12 patients (13 shoulders) suffering from a delayed managed posterior fracture dislocation were managed. Our inclusion criteria were adult patients less than 60years presented with reverse Hill-Sachs impression defects from 20 to 50% with or without fractures. For all patients, the dual subscapularis procedure was done. UCLA score was used for postoperative functional assessment. After a minimum follow-up of 6months, the results of UCLA score were excellent/good in eight patients and fair/poor in five patients. All patients were found stable after open reduction ± internal fixation with no reported complications. There was a significant correlation of the UCLA score and non-abuse or lower doses of tramadol and the shorter interval between trauma and procedure. Twelve patients were satisfied after the operation. Reconstructing the reverse Hill-Sachs defect with the dual subscapularis technique provides adequate stability, pain relief, and function in patients with locked chronic posterior shoulder fracture/dislocation. The used technique has the merit of versatility with different fracture patterns, improved fixation of the tendon and increasing the tendon's footprint that ensures extra-articular location of the defect. II.

Arthroscopic Knotless Remplissage for the Treatment of Hill-Sachs Lesions Using the PASTA Bridge Configuration

Recurrent glenohumeral dislocations can produce Hill-Sachs lesions—bony defects on the humeral head resulting from the humerus hitting the glenoid during dislocations. Some of these lesions can engage on the glenoid during motion, producing instability and potentially affecting the success of a labral repair. The remplissage was developed to address these Hill-Sachs lesions and improve stability. French for “filling,” the goal of the remplissage is to fill the Hill-Sachs lesion with the infraspinatus tendon, preventing the margins of the lesion from engaging with the glenoid. Analogous to restoring the rotator cuff footprint during repair, a primary goal of the remplissage is to have the infraspinatus cover the Hill-Sachs lesion. The partial articular supraspinatus tendon avulsion (PASTA) bridge was originally developed for partial-thickness rotator cuff repair in situ, but additional uses have been found in other settings. The PASTA bridge uses a medial row horizontal mattress with a lateral anchor to create a linked construct to effectively distribute force and provide adequate coverage of the lesion. Knotless anchor technology used in this procedure prevents the need for arthroscopic knot tying and potentially damaging knot stacks. This Technical Note describes a remplissage technique using the PASTA bridge configuration to address Hill-Sachs lesions associated with recurrent glenohumeral instability.

Clinical outcomes of the reverse McLaughlin procedure for Hill-Sachs lesions in anterior shoulder instability.

Engaging Hill-Sachs lesions in recurrent anterior shoulder dislocation have been managed with the remplissage procedure. Clinical and cadaveric studies have reported limitation of rotation after this procedure. We introduce the reverse McLaughlin procedure where the infraspinatus and the underlying capsule are detached and approximated into the Hill-Sachs defect with transosseous sutures. This is a preliminary report using this technique. Seventeen patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion underwent a Bankart repair and remplissage procedure (n = 9) or the reverse McLaughlin procedure ( n = 8). Patients were evaluated using the SF-36, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Clinical assessment of the shoulders was also performed. At the final follow-up, all patients in both groups achieved comparable clinical outcome scores. No significant differences were reported in the range of motion of the shoulders between the two groups. There was one dislocation of the operated shoulder in each group after an injury. The reverse McLaughlin procedure for engaging Hill-Sachs lesions is simple, easy to perform, and associated with functional outcomes and range of motion at least equivalent to those obtained via the remplissage technique. It may be an alternative to the latter procedure. III, Retrospective Comparative Study.

Current concepts in revision hip arthroscopy.

Hip arthroscopy is an evolving procedure and its indications have expanded. The number of patients undergoing this procedure has increased significantly as well as the number of surgeons being trained. This has resulted in a notable increase in post-operative complication rates creating the need to develop advanced hip arthroscopic techniques. Revision hip arthroscopy is often complex and many factors should be considered to achieve a satisfactory clinical outcome. Careful pre-operative planning and agreement of expectations between the physician and patient regarding the procedure are important. This review describes several advanced treatment options that are used mainly in revision or complex primary hip arthroscopy cases. Labral reconstruction or augmentation technique is used in cases of severely deficient acetabular labral tissue to restore the fluid seal mechanism. In cases of symptomatic (often post-operative) adhesion formation, a spacer between the labrum and the joint capsule is useful for pain relief and prevention of future adhesions. Large defects of the capsule due to previous unrepaired capsulotomy or any other cause can be addressed with the capsular reconstruction technique. Ligamentum teres reconstruction using an anterior tibialis allograft is indicated in patients with hip instability and persistent pain after previous debridement or with complete tears of this structure. The senior author's treatment of choice in cases of previous over-resection of CAM impingement is the remplissage technique to restore the bony defect of the femoral head-neck junction and preserve the joint seal.

Resultados clínicos e de imagem da abordagem da lesão de Hill‐Sachs pela técnica de remplissage na instabilidade anterior do ombro

ObjectiveTo evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of infraspinatus tendon on Hill‐Sachs lesion, and the degree of fatty infiltration of infraspinatus muscle and its postoperative strength. MethodsTwenty‐five patients with recurrent anterior dislocation of the shoulder and Hill‐Sachs lesion with a Hardy index greater than 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow‐up of one year. Patients underwent clinical evaluation (functional scores of Carter‐Rowe and Walch‐Duplay, measurement of range of motion and strength) and magnetic resonance imaging on the operated shoulder. Results88% and 92% of the patients had good or excellent scores on functional assessments for the Carter‐Rowe and Walch‐Duplay scores, respectively. A mean difference of 1kg less in operated limb strength was observed when compared with the contralateral limb (p<0.001), as well as a mean difference of 10° in external rotation 1 and 2 (p<0.001), again using the contralateral side. All the patients who underwent magnetic resonance imaging presented high‐grade filling of the Hill‐Sachs lesion by capsulotenodesis, as well as absence or minimal fatty infiltration in infraspinatus muscle. ConclusionThe remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill‐Sachs defect were demonstrated.

Arthroscopic remplissage: Is it still an option?

Posterolateral humeral head defects can be large and engage on the anterior glenoid, and they usually contribute to anterior shoulder instability in 40% to 90% of cases.The purpose of this study is to evaluate the results of the largest series of patients who underwent arthroscopic remplissage with Bankart repair for recurrent anterior shoulder instability due to associated Bankart lesions, with large and engaging (> 25% involvement) humeral Hill-Sachs defects (HSDs).A total of 51 patients underwent arthroscopic Bankart repair with remplissage technique for the treatment of recurrent anterior glenohumeral instability with large and medial HSDs. Pre-operative imaging in all patients identified a Bankart lesion with an associated HSD that involved > 25% of the humeral head. The Rowe score was used to assess the patients clinically.A total of 46 patients were male. The mean age of the patients was 28.7 years (18 to 43). The mean follow-up period was 31 months (20 to 39). At the final follow-up, three patients reported recurrence of instability (two dislocations and one subluxation). The mean Rowe score improved to 95.4 points (function, 45.5 of 50; stability, 26.4 of 30; motion, 8 of 10; pain, 8 of 10).The arthroscopic remplissage technique with Bankart repair gave satisfactory results and is still considered to be an effective, safe and reliable procedure for treatment of glenohumeral instability in cases with large and medial HSDs.Cite this article: EFORT Open Rev 2017;2:478–483. DOI: 10.1302/2058-5241.2.160070

Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss

Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.