Arthroscopic Remplissage
What is a remplissage?
The term “remplissage” is French for “fill in”. The arthroscopic remplissage is a procedure that is performed in conjunction with an arthroscopic Bankart/labrum repair to treat the Hill-Sachs lesion, which is a dent in the humeral head. Hill-Sachs lesions can be problematic, especially when associated with bone loss in the anterior glenoid, because when the Hill-Sachs encounters the glenoid, it is at risk of “engaging” or locking and levering the ball out of the socket. Patients with Hill-Sachs lesions and glenoid bone loss have higher rates of failure of isolated Bankart repairs; remplissage can be a useful adjunct to minimize the rate of recurrence after arthroscopic repair(1).
The arthroscopic remplissage is a relatively simple and noninvasive technique, where one of the rotator cuff tendons (infraspinatus) is fixated into the Hill-Sachs lesion using knotless suture anchors. Adding this procedure just minimally increases the complexity of the arthroscopic Bankart repair but does not in any way change the recovery process. By “filling in” the infraspinatus into the defect, the Hill-Sachs lesion is technically extracapsular or outside the shoulder joint, because the injured dent portion of the bone is filled with tendon.
The criteria for remplissage is dependent on the age and activity goals of the patient, the size of the Hill-Sachs lesion, and whether there is bone loss at the anterior glenoid. Sometimes remplissage can be utilized in selected patients in the revision setting where prior arthroscopic Bankart repair has failed. While there are objective measurements that can be performed on an MRI scan to guide the surgeon(2) as to whether to include a remplissage, some general guidelines can be followed. Patients that are younger, play contact sports, have larger Hill-Sachs lesions with glenoid bone loss, and perhaps that have failed prior surgery are sometimes good candidates for arthroscopic remplissage.
Remplissage is not required for all Hill-Sachs lesions, however. The reason not to routinely perform the remplissage is that some patients at lower risk of recurrence (more recreational athletes, smaller Hill-Sachs lesions) can achieve excellent outcomes with isolated labrum repair and avoidance of treatment of the Hill-Sachs lesion. Overuse of the remplissage in these individuals can risk over-tightening the shoulder and causing stiffness.
On the other hand, patients that have severe Hill-Sachs lesions, substantial glenoid bone loss (called “critical” bone loss), and that have failed multiple arthroscopic procedures may need bone augmentation of the glenoid to address the Hill-Sachs lesion. While this is uncommon, these patients may require advanced reconstruction of the bone of the glenoid (such as the Latarjet procedure). However, the fraction of patients requiring advanced bony reconstruction keeps declining, in part because arthroscopic technique and knotless suture anchor innovations continues to improve the outcomes of remplissage compared with other more invasive options(1).
The recovery from arthroscopic remplissage is not substantially different compared with the recovery expected with arthroscopic labrum repair. The procedure is done minimally invasively under a light general anesthetic and a regional shoulder block that allows the patient to awaken immediately after surgery and leave the facility. A sling is generally maintained for six weeks and return to full activity is permitted generally between 3 and 6 months.
Schedule a shoulder exam
To learn more about the Arthroscopic Remplissage procedure, book an appointment with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer specializes in diagnosing and treating shoulder injuries. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
References:
- Hurley ET, Toale JP, Davey MS, Colasanti CA, Pauzenberger L, Strauss EJ, Mullett H. Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020 Dec;29(12):2487-2494. doi: 10.1016/j.jse.2020.06.021. Epub 2020 Jul 7. PMID: 32650087.
- Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014 Jan;30(1):90-8. doi: 10.1016/j.arthro.2013.10.004. PMID: 24384275.
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Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
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