Remplissage as a concept and role in instability

Anterior instability of the shoulder is characterised by bipolar lesions – the Bankart lesion with glenoid bone loss on ‘glenoid side’ and the Hill- Sach's defect (HSD) on the ‘humeral head’. It is well known that the recurrence of the dislocation is likely to be more frequent even after surgical repair in the presence of these lesions. Currently, by and large, two surgical options are available to address the glenoid side lesion: Bankart repair (soft tissue procedure) or Latarjet procedure (Bony procedure). Both the procedures have stood the test of time and have proved to be reliable and reproducible. Based on the amount of glenoid bone loss (roughly, the cut off at 25%) choice of surgery offered for this condition is reasonably straight forward. Bankart repair (Arthroscopic/open) for <25% bone loss and Latarjet for>25% bone loss is widely practiced. Although the Hill-Sachs defect remains very frequent in almost all cases of anterior instability of the shoulder, the role and management offered for Hill-Sach's defect remains debatable and controversial. Various surgical procedures have been described to correct Hill Sach's defect include filling of the defect with infraspinatus (remplissage) or bony procedures like reconstruction with an osteoarticular humeral head allograft or partial resurfacing arthroplasty. This review discusses the role of Remplissage procedure with respect to Bankart repair in cases with medium to large Hill Sachs defects.