Remplissage - Surgical Technique

  

 

 

In addition to anterior glenoid bone loss, patients with traumatic shoulder instability may also experience bone loss of the posterolateral humeral head, often referred to as a Hill-Sachs lesion. Depending on the size and position of the Hill-Sachs lesion, the lesion may engage with the anterior glenoid rim upon certain movements. The role that Hill-Sachs lesions play in recurrent instability1 have led many to address them through a technique called Remplissage. In this technique, the lesion is "filled" by infraspinatus tenodesis and posterior capsulodesis to prevent the lesion from engaging with the glenoid rim. Many studies have shown favorable results in using Remplissage to address Hill-Sachs lesions and prevent recurrent dislocation, reporting failure rates of 0-15%2-7


1Palmer I, Widen A. The bone block method of recurrent dislocation of the shoulder
joint. J Bone Joint Surg 1948;30: 53-58.

2Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs remplissage: An arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2008;24:723-726.
 
3Park MJ, Tjoumakaris FP, Garcia G, Patel A, Kelly JD. Arthroscopic remplissage with Bankart repair for the treatment of glenohumeral instability with Hill-Sachs defect. Arthroscopy 2011;27:1187-1194.
 
4Nourissant G, Kilinc AS, Werther JR, Doursounian L. A prospective, comparative, radiological and clinical study of the influence of the “Remplissage ”procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair. Am J Sports Med 2011;39:2147-2152
 
5Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “remplissage”: Capsulotenodesis of the engaging large Hill-Sachs lesion. J Orthop Surg Res 2011;6:1-5
 
6Zhu Y, Zhang J, Shen J, Jiang C. Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: A report of 49 cases with a minimum 2-year follow-up. Am J Sports Med 2011;39:1640-1647
 
7Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Joint Surg Am 2012;94:618-626.


 

What our customers have to say."During the development of my augmentation technique, I did extensive research on both allograft and xnograft options. I ultimately chose the Allopatch HD® because of its aseptic harvesting technique, lack of terminal irradiation, and its excellent biomechanical and biochemical properties. Coupling this with the Y-Knot® system, we have created a minimally invasive, yet solid and durable fixation of the allograft to the underlying tendon repair, thus providing a structural component in addition to the extracellular matrix for tendon healing. This provides an avenue for potentially better care for both revision patients and the at-risk primary repair with questionable tendon quality."

- Jovan R. Laskovski, MD
Paid CONMED consultant