Simplified Double-Pulley Remplissage With Knotless All-Suture Anchor Fixation Using a Digital Subdeltoid Retrieval Method.

Abstract

Anterior shoulder dislocations represent one of the most common joint dislocations, with particular populations at increased risk of recurrence. Associated bone loss further increases the risk of dislocation and often needs to be addressed via soft tissue or bony augmentation. In particular, for large Hill-Sachs lesions in patients at increased risk of dislocation, remplissage is indicated. This current technique builds upon previously double-pulley techniques and utilizes a knotless all-suture anchor construct that allows for maximization of anchor spread within an associated Hill-Sachs lesion. The knotless all-suture anchor constructs are placed percutaneously under direct visualization through a routine posterior portal. After completion of any associated labral repair, the posterior incision is expanded, and the sutures are retrieved via digital dissection to facilitate a double-pulley repair. The benefits of this technique include maximization of anchor spread, use of an already established routine portal, forgoing time-consuming arthroscopic access to the subacromial space, and a knotless construct that optimizes outcomes without compromising strength. Additionally, retrieval of the sutures under direct visualization through the expanded posterior portal decreases the likelihood of tissue bridge formation.