ARTHROSCOPIC REMPLISSAGE FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY Current and Evolving Concepts

>> A Hill-Sachs lesion (HSL) is a compression fracture on the posterolateral humeral head that can increase the risk of recurrent shoulder instability after isolated arthroscopic Bankart repair. >> Remplissage involves capsulotenodesis of the infraspinatus tendon and posterior capsule into the HSL to prevent its engagement with the glenoid rim through extra-articular conversion and restraint against humeral head anterior translation. >> The glenoid track concept can be applied preoperatively and intraoperatively to evaluate risk of recurrence and help direct clinical management options for recurrent shoulder instability. >> Recent literature supports expanding indications for remplissage to include patients with on-track HSLs who are at increased risk of recurrence including collision athletes, military personal, and patients with joint hyperlaxity. >> New techniques and suture constructs have demonstrated improved biomechanical strength while avoiding the need to access the subacromial space.