Remplissage is a non-anatomic technique that directly addresses the Hill-Sachs lesion.
Consequently, greater external rotation is required for engagement of the Hill-Sachs lesion.
While this procedure does not directly address the Hill-Sachs lesion, it does restore articular arc length.
Preoperative analysis of the Hill-Sachs lesion in anterior shoulder instability: how to predict engagement of the lesion.
Arthroscopic double-pulley reimplissage technique for engaging Hill-Sachs lesions
in anterior shoulder instability repairs.
In addition, direct bone grafting for large Hill-Sachs lesions with allograft humeral head or femoral head has recently been advocated for "engaging Hill-Sachs lesions" as well.
We report on a small series of cases from 2002-2008 at our institution of anterior glenohumeral instability, with severe bone loss, treated using either open femoral head and humeral head allograft reconstruction of the humeral head for large Hill-Sachs lesions, or open allograft and autograft iliac crest reconstruction of the glenoid rim for severe glenoid bone loss.
Five patients were identified who underwent allograft reconstruction of large Hill-Sachs lesions (1 female and 4 males).
44) The operative procedure to be performed is dependent on the size and location of the Hill-Sachs lesion, the bone quality and quantity of the humeral head, the presence of underlying degenerative changes, the size of the glenoid rim fracture, and the chronicity of the injury.
They concluded that: 1) arthroscopic Bankart repair is comparable to open repair if no "significant" structural bone loss (engaging Hill-Sachs lesion or inverted-pear glenoid) exists; 2) contact athletes without such deficits may be treated with arthroscopic repair without compromising results; 3) the presence of such defects is a relative contraindication to arthroscopic repair; and 4) such defects should be addressed with coracoid transfer to increase stability.
Bone grafting may be indicated in cases of instability associated with a Hill-Sachs lesion involving 20% to 45% of the articular arc (36) or in cases of glenoid rim loss greater than 20%.
A posteromedial Hill-Sachs lesion tends to engage the anterior glenoid rim with less external rotation than more posterolateral lesions.