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1. E. Mataragas, C. Vassos, N. Tzanakakis, G. Mouzopoulos,
C.K. Yiannakopoulos, Emm. Antonogiannakis
2nd
Orthopaedic Dpt. – Shoulder and Arthroscopy Unit,
IASO GENERAL Hospital
OUR EXPERIENCE WITH “REMPLISSAGE”
IN CASES WITH HUMERAL BONE LOSS
HILL-SACHS DEFECTS

2. BACKGROUND
Hill Sachs Lesion
 Impression fracture of the posterolateral
humeral head;
 Present in 90% of anterior dislocations and
25% of anterior subluxations. (Calandra JJ,
Arthroscopy 1989;5:254)
 Can also be reverse.

3. GRADING
 Less than 20% of head (minor)
 Between 20-45% of head (moderate)
 Greater than 45% of head (severe)

4. GRADING
Burkhart SS, De Beer JF : Arthroscopy 2003;19 : 732–739
Engaging
Non Engaging

5. GRADING
Arthroscopic
 Grade I: defect in the articular surface down to
subchondral bone
 Grade II: includes the subchondral bone
 Grade III: large subchondral defect
Calandra et. Al, 1989

6. GUIDELINES
Most Hill-Sachs lesions are small and don’t
require treatment.
Each lesion should be evaluated during surgery.
Require treatment:
- Lesions found to be engaging in a normal ROM.
- Lesions representing >30% of the articular surface.

7. TREATMENT OPTIONS
Humeral rotation osteotomy (Weber BG, JBJS
1984;66A:1443)
Hemiarthroplasty / TSA for patients
>50y/o (Flatow E, JSES 1993;2:2)
Humeral head allograft (Gerber C, JBJS 1996;78A:376)
Remplissage (Wolf EM, Arthrosopy 2004;20(suppl1) :e14)

8. PURPOSE
To evaluate the Remplissage arthroscopic technique
as described by Eugene Wolf used in patients with
traumatic shoulder instability that present glenoid
bone loss and Hill Sachs defects.

9. STUDY DESIGN
 Retrospective, continuous, monocentric
 Series of 28 patients
Epidemiology 23M, 5F
-Mean age of patients: 31
1st
episode: 20
dislocations: 24
-Revision surgery: 4
-Joint hypermobility: 14
Sport Participation
Athletes: 18
8 Overhead
0 Contact
10 Overhead & Contact
No sports: 10

10. STUDY DATA
 Follow up ranged from 5-28 months
(Mean=18).
 Post op rehabilitation was supervised by a
doctor dedicated to shoulder problems.
 Recurrence and functional outcome were
evaluated pre-op and post-op with the Rowe
Zarins Score.

11. ARTHROSCOPIC SURGERY
One Surgeon (A.E.) performed all the procedures.
 The arthroscopic procedure performed was the
Remplissage technique as described by Eugene
Wolf in conjuction with a typical soft tissue
repair.

12. OPERATIVE FINDINGS
 Osseous Lesions:
Hill Sachs 28
Large or medium Glenoid loss 11
“Inverted pear” glenoid shape 4
“Bony” Bankart Lesion 6
Osteoarthritis 0

13. OPERATIVE FINDINGS
 Soft Tissue Lesions:
Bankart Lesions 22 22/28 (78,6%)
SLAP 11 11/28 (39%)
Supraspinatus Tear 1 1/28 (3,6%)
Capsular Distention 3 3/28 (10,7%)

14. “REMPLISSAGE” TECHNIQUE
 The Hill-Sachs lesion is freshened with a bur.

15. “REMPLISSAGE” TECHNIQUE
 A cannula is inserted in the posterior portal
through the deltoid and an anchor is placed in
the inferior aspect of the humeral lesion.

16. “REMPLISSAGE” TECHNIQUE
 A penetrating grasper is passed through the
tendon and posterior capsule, 1 cm inferior to
the initial portal entry site to pull 1 suture
limb.

17. “REMPLISSAGE” TECHNIQUE
 The inferior suture is tied first with the knots
remaining extra-articular, pulling the
infraspinatus and capsule into the lesion.

18. SUBJECTIVE RESULTS
 Patient Satisfaction
28 Very Satisfied/Satisfied 100%
 Return to Work 100%
 Return to Sports
10 on the same level 55,5%
8 on lower level 45,5%

19. FUNCTIONAL RESULTS
Pre-Op Post-Op p
Rowe Zarins 23 97 < .0001

20. RESULTS ON STABILITY
 No reccurent Dislocations so far

21. RESULTS ON PAIN
 9 shoulders remained painful
1 effort (7 months post-op), 8 barometric
2 had previous procedures
All 9 patients described the pain as minimal.
 No patients presented O.A.

22. R.O.M.
 10 patients showed decrease in external
rotation (arm at the side) 0ο
-15ο

23. CONCLUSION
 The “Remplissage” technique in patients with
humeral bone loss seems to offer so far excellent
post op results despite the slight decrease in the
external rotation of the shoulder.