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Patients with anterior shoulder instability and an engaging Hill-Sachs lesion are at higher risk of recurrent instability after isolated Bankart repair. A randomized controlled trial evaluated whether adding arthroscopic remplissage to Bankart repair improves outcomes in patients with an engaging humeral head defect. The procedure converts the Hill-Sachs lesion into a more extra-articular configuration and is designed to reduce the chance that the defect will engage the glenoid rim during motion. In the trial, addition of remplissage reduced recurrent instability without producing a major penalty in overall shoulder function. The results support a “bipolar lesion” mindset in instability surgery: successful treatment depends not only on the labrum and glenoid but also on the size and engagement characteristics of the humeral defect. For surgeons, careful preoperative imaging and assessment of bone loss remain essential. Remplissage is particularly relevant when the humeral lesion is substantial but glenoid bone loss is not so advanced that a bone-block procedure would be preferred. The paper therefore supports a tailored instability algorithm rather than a one-size-fits-all arthroscopic repair.
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Patients with anterior shoulder instability and an engaging Hill-Sachs lesion are at higher risk of recurrent instability after isolated Bankart repair. A randomized controlled trial evaluated whether adding arthroscopic remplissage to Bankart repair improves outcomes in patients with an engaging humeral head defect. The procedure converts the Hill-Sachs lesion into a more extra-articular configuration and is designed to reduce the chance that the defect will engage the glenoid rim during motion. In the trial, addition of remplissage reduced recurrent instability without producing a major penalty in overall shoulder function. The results support a “bipolar lesion” mindset in instability surgery: successful treatment depends not only on the labrum and glenoid but also on the size and engagement characteristics of the humeral defect. For surgeons, careful preoperative imaging and assessment of bone loss remain essential. Remplissage is particularly relevant when the humeral lesion is substantial but glenoid bone loss is not so advanced that a bone-block procedure would be preferred. The paper therefore supports a tailored instability algorithm rather than a one-size-fits-all arthroscopic repair.
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