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

Background: 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. Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the "engaging" nature 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. 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). Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. 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.