Arthroscopic Anterior Labral Repair and Remplissage in a Young, Active Athlete

Abstract

Background: Arthroscopic remplissage is an effective adjunct for anterior shoulder stabilization in patients with large engaging Hill-Sachs lesions (HSLs) and without significant glenoid bone loss or on-track HSLs with high risk of recurrence. Indications: The arthroscopic remplissage shown was performed in a patient with a high-risk profile for recurrence (age <25, near track) following a first-time traumatic anterior dislocation event. In this specific case, the remplissage was used to fill a near-track HSL, a significant risk factor for recurrence. Technique Description: Following diagnostic shoulder arthroscopy, the anterior labral repair is started with placement of the most inferior anchor and passage of the suture around the labrum and capsule. This anchor is not tightened to allow visualization and access to the posterior humeral head. Posterior labral work is then performed if there is a posterior labral tear extension. Next, for the remplissage, 2 double loaded suture anchors are placed spanning the HSL and passed through the capsule/infraspinatus without tightening. The prior placed anterior inferior anchor is then tightened. The remaining anterior labrum is then completed with capsulorraphy using additional 3 knotless suture anchors. Finally, the remplissage is completed using a double pulley method to pull the posterior capsule into fill the HSL. Results: Based on literature and the author's experience, addition of a remplissage for arthroscopic anterior stabilization in patients with anterior glenohumeral instability and either off-track HSL, or on-track HSL with high risk of recurrence can significantly reduce rates of recurrent instability when compared to arthroscopic Bankart repair alone. Discussion/Conclusion: Arthroscopic remplissage is an effective adjunct for arthroscopic anterior instability in patients with off-track HSLs or on-track HSLs with high risk of recurrence that is efficient with low surgical complication risk when performed with proper technique. 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.