Arthroscopic Hill-Sachs Remplissage with Bankart Repair: Strategy and Technique.

INTRODUCTION

Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability.

STEP 1 ANTERIOR CAPSULOLABRAL MOBILIZATION AND GLENOID PREPARATION: Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature of the Hill-Sachs defect.

STEP 2 PREPARATION OF THE HILL-SACHS DEFECT: With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus.

STEP 3 REMPLISSAGE WITH THE POSTERIOR ASPECT OF THE CAPSULE AND INFRASPINATUS TENDON: Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm).

STEP 4 ANTERIOR BANKART REPAIR: Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair.

STEP 5 POSTOPERATIVE REHABILITATION PROTOCOL: Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months.

RESULTS

In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively.IndicationsContraindicationsPitfalls & Challenges.