AOSSM/AANA Specialty Day 2020-Arthroscopic Stabilization with Remplissage

Arthroscopic Stabilization with Remplissage_ Listen Why

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This presentation by John D. Kelly IV, MD, explores surgical strategies for shoulder instability involving Hill-Sachs lesions and glenoid bone loss, focusing on the arthroscopic remplissage procedure versus the open Latarjet procedure.<br /><br />Key points highlight that remplissage is a biologic, minimally invasive technique that "fills" the Hill-Sachs lesion by performing an infraspinatus tenodesis, thus preventing engagement of the humeral head, restoring native anatomy, and preserving capsule tension without causing stiffness. It shifts the glenoid track medially, lowering risk of dislocation and may even lead to bony-like tissue formation over time. Multiple studies show remplissage yields excellent outcomes in patients with minimal to moderate (up to ~25%) glenoid bone loss, with high return-to-sport rates, minimal loss of external rotation, low recurrence, and few complications.<br /><br />Conversely, the open Latarjet expands the glenoid track by adding a bone graft to address larger bone defects, but carries risks such as subscapularis morbidity, arthritis (up to 49%), graft resorption, and longer recovery. Open surgery compromises anatomy and labral integrity, which are critical for joint stability and protection.<br /><br />The presentation emphasizes preserving anatomy—particularly the labrum—to maintain the "bumper" effect and suction seal. Capsulolabral augmentation through arthroscopy enhances stability and joint contact mechanics. Addressing both glenoid and humeral head lesions biologically leads to better outcomes and avoids unnecessary pain and complications.<br /><br />The conclusion recommends remplissage for all Hill-Sachs lesions and adding bone grafting for glenoid deficits. When glenoid bone loss is substantial, a Latarjet may be necessary but carries higher risk. Overall, remplissage offers a softer, kinder, and more physiologic alternative for shoulder stabilization with fewer complications and effective long-term results.

Keywords

shoulder instability

Hill-Sachs lesion

glenoid bone loss

arthroscopic remplissage

open Latarjet procedure

infraspinatus tenodesis

capsulolabral augmentation

glenoid track

bone grafting

shoulder stabilization