Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ?

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 7-10 |  Nilesh Kamat, Ashutosh Ajri, Vivek M Sodhai, Vikrant Kalamb, Ashok K Shyam, Parag K Sancheti

Authors:  Nilesh Kamat [1], Ashutosh Ajri [1], Vivek M Sodhai [1], Vikrant Kalamb [1], Ashok K Shyam [1,2], Parag K Sancheti [1]

[1] Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Vivek Sodhai
Clinical Fellow, Department of Orthopaedics,
Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.


Background: To determine the effect of Remplissage procedure with Bankart repair compared to standard Bankart repair alone on resultant external rotation of the shoulder in patients of anterior shoulder instability with engaging Hill-Sach’s lesion.
Methods: Out of 46 patients, 18 patients underwent arthroscopic Remplissage combined with Bankart repair (group I) and the other 28 patients underwent arthroscopic standard Bankart repair alone (group II). Clinical outcomes were retrospectively evaluated by assessing the range of motion, complications, recurrence rates, and functional results were assessed utilizing the UCLA and ROWE score.
Results: Average follow-up period of 23.88 ± 5.26 (range, 12-48) months. Average external rotation loss compared to normal side in group I was of 5.00° ± 0.44° (range, 70°-90°)( p=0.031) in external rotation in abduction and 1.67° ± 0.18° (range, 75°-90°)( p=0.36 ) in external rotation in neutral at the last follow up and in group II it was 0.86°±0.35° (range, 70°-90°)( p=0.559 ) in external rotation in abduction and 0.89° ± 0.38° (range, 70°-90°)( p=0.646 ) in external rotation in neutral at the last follow-up. The average UCLA score was 34.00 ± 1.46 (range, 32-35) in group I and 33.29 ± 1.86 (range, 30-35) in group II (p=0.154). Average Rowe score was 92.22 ± 6.24 (range, 95-100) in the group I and 96.55±5.99 (range, 90-100) in the group II (p=0.025).
Conclusion: The addition of Remplissage procedure with standard Bankart repair causes significant loss of external rotation in abduction in patients of engaging Hill-Sach’s lesion compared to standard Bankart repair alone.
Level of Evidence: Level III
Keywords: Anterior shoulder instability, Remplissage procedure, Bankart’s repair, External rotation, Hill-Sach’s lesion.


1. Bessière C, Trojani C, Carles M, Mehta SS, Boileau P. The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair. Clin Orthop Relat Res 2014;472(8):2345–51. doi:10.1007/s11999-014-3550-9
2. Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs Remplissage. J Bone Joint Surg Am. 2012;94(7):618-26. Doi: 10.2106/JBJS.K.00101
3. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to a failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16(7):677-694. doi:10.1053/jars.2000.17715
4. Connolly RS. Humeral head defects associated with shoulder dislocations: Their diagnostic and surgical significance. Instr Course Lect 1972;21:42-54.
5. Deutsch AA, Kroll DG. Decreased range of motion following arthroscopic Remplissage. Orthopedics 2008;31(5):492. PMID: 19292311
6. Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA, et al. The effect of the Remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am 2012;94(11):1003–12. Doi: 10.2106/JBJS.J.01956
7. Franceschi F, Papalia R, Rizzello G, Franceschetti E, Del Buono A, Panascì M, et al. Remplissage repair: new frontiers in the prevention of recurrent shoulder instability: a 2-year follow-up comparative study. Am J Sports Med. 2012;40(11):2462-9. Doi: 10.1177/0363546512458572
8. Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “Remplissage”: capsulotenodesis of the engaging large Hill-Sachs lesion. J Orthop Surg Res 2011;6(1):29. doi:10.1186/1749-799x-6-29
9. Kazel MD, Sekiya JK, Greene JA, Bruker CT. Percutaneous correction (humeroplasty) of humeral head defects (Hill-Sachs) associated with anterior shoulder instability: a cadaveric study. Arthroscopy. 2005;21(12):1473-8. doi: 10.1016/j.arthro.2005.09.004
10. Koo SS, Burkhart SS, Ochoa E. Arthroscopic double-pulley Remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs. Arthroscopy 2009;25(11):1343-1348. doi:10.1016/j.arthro.2009.06.0115.
11. Krackhardt T, Schewe B, Albrecht D, Weise K: Arthroscopic fixation of the subscapularis tendon in the reverse Hill-Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder. Arthroscopy 2006,22(2):227.e1-227.e6. doi:10.1016/j.arthro.2005.10.004
12. Kronberg M, Brostrom LA. Proximal humeral osteotomy to correct the anatomy in patients with recurrent shoulder dislocations. J Orthop Trauma. 1991;5(2):129-33. Doi: 10.1097/00005131-199105020-00002
13. Miniaci A, Berlet G. Recurrent anterior instability following failed surgical repair: allograft reconstruction of large humeral head defects [Abstract]. J Bone Joint Surg Br. 2001;83(Suppl 1):19-20.
14. Moros C, Ahmad CS: Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability. Orthopedics 2009, 32(8). doi: 10.3928/01477447-20090624-21
15. Nourissat G, Kilinc AS, Werther JR, Doursounian L. A prospective, comparative, radiological, and clinical study of the influence of the “Remplissage” procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair. Am J Sports Med. 2011;39(10):2147-52. Doi: 10.1177/0363546511416315
16. Park MJ, Garcia G, Malhotra A, Major N, Tjoumakaris FP, Kelly JD 4th. The evaluation of arthroscopic Remplissage by high-resolution magnetic resonance imaging. Am J Sports Med. 2012;40(10):2331-6. Doi: 10.1177/0363546512456974
17. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sach’s “Remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2008;24(6):723-6. Doi: 10.1016/j.arthro.2008.03.015
18. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984;66(9):1443-50. PMID: 6501339.

How to Cite this article: Kamat N, Ajri A, Sodhai VM, Kalamb V, Shyam AK, Sancheti PK | Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ? | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1):7-10.

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