Editorial Commentary: Indications for Augmenting Arthroscopic Bankart Procedure With Remplissage in Patients With Nonengaging Hill-Sachs Lesions Must Be Individualized Based on Surgeon and Patient.

Abstract

Arthroscopic remplissage has been suggested as a means to decrease recurrent instability in arthroscopic Bankart repair surgery involving patients with significant Hill-Sachs lesions. Remplissage fills the Hill-Sachs lesion to prevent glenohumeral "engagement" and recurrent instability. Remplissage is not generally indicated in patients with smaller, nonengaging Hill-Sachs lesions. However, a recent review suggests that by expanding the indications to nonengaging Hill-Sachs lesions, recurrence of shoulder instability may be lower in patients having arthroscopic Bankart repair. Further, the review suggests that patients having Bankart plus remplissage did not lose shoulder external rotation range of motion. A concern, in addition to follow-up that likely results in underestimation of recurrence, is that anatomically, remplissage should decrease external rotation, and manual measurement of external rotation could reflect compensatory scapulothoracic motion. This is a particular problem for throwing athletes.