Remplissage Surgery for Shoulder Instability

A Hill-Sachs lesion is a compression fracture or divot on the back of the humeral head (the ball-like part of the upper arm bone) that is caused by the humeral head hitting the glenoid (the socket part) during a complete or partial shoulder dislocation. A Hill-Sachs lesion can predispose to shoulder instability and increases the risk of future dislocations.

Hill-Sachs lesions can be found in 67% to 93% of anterior shoulder dislocations, and some studies have even measured an incidence of 100% in patients with anterior shoulder instability.

The word “remplissage” is French for “filling”. In the context of this procedure, it refers to the filling of the Hill-Sachs lesion with soft tissue to prevent further dislocations. The remplissage procedure is arthroscopic and fills the defect with a tendon, which has proven to be the most successful treatment for a Hill-Sachs lesion. Arthroscopic remplissage surgery is an effective, safe and reliable procedure to treat shoulder instability due to Hill-Sachs lesions. It is shoulder preserving surgery and may limit the need for more complex shoulder reconstructions in the setting of glenoid or humeral bone loss.

During a remplissage procedure, Dr. Petrigliano will use arthroscopic techniques to visualize and access the shoulder joint. He will then convert the Hill-Sachs lesion into a more stable form by filling it in. This is typically done by arthroscopically anchoring the infraspinatus tendon and the posterior capsule of the shoulder into the lesion. The filled defect then heals over time, turning into a more fibrous, less mechanically disadvantaged area. The remplissage procedure effectively makes the shoulder more stable and less likely to dislocate.

This procedure is typically performed alongside a Bankart repair, which addresses damage to the shoulder labrum and ligaments at the front of the shoulder that often accompanies shoulder dislocations. This will restore the overall stability and function of the shoulder.

Symptoms are typically those associated with shoulder instability or dislocation, and may include:

• Recurrent shoulder dislocations or subluxations: The shoulder may repeatedly come out of its socket partially (subluxation) or completely (dislocation).
• Pain: This might be persistent or might occur only when moving the shoulder.
• Limited range of motion: Difficulty moving the shoulder, particularly in certain directions.
• Clicking, popping, or grinding sensation: You might feel or hear these sensations when you move your shoulder.
• Weakness: The shoulder might feel weak, particularly when trying to lift objects or when performing overhead activities.
• Swelling and bruising: These may occur immediately after a dislocation event.
• Sensation changes: Some people experience numbness or tingling in the arm or hand after a dislocation.

Dr. Petrigliano will review your medical history and inquire about how you injured your shoulder including all incidences of shoulder dislocations.  He will evaluate your shoulder and order imaging studies, such as X-rays, MRI, or CT scans, to detect a Hill-Sachs lesion and any other associated injuries. With this information he will recommend appropriate treatment options including remplissage.

The remplissage technique employed to repair anterior shoulder dislocation with humeral bone loss provides good results including shoulder stability and acceptable rates of return to sports, even in a mid- to long-term follow-up.