Arthroscopic Barkart repair and Remplissage procedure would stabilize the torn anterior labrum, and also advance the infraspinatus tendon into the Hill-Sach's defect thereby preventing recurring engagement of the posterior humeral defect and the anterior labrum in the 90/90 position.
The clinical scenario consistent with a chronic Bankart tear and an engaging Hill-Sachs lesion causing anterior shoulder instability and engagement of the Hill-Sachs lesion when the arm is in the 90/90 position.
The Remplissage procedure is indicated for patients with a large (>25%) humeral head deficiency.
Zhu et al reported on arthroscopic Bankart repair combined with Remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesions. They reported good results in 49 patients and concluded the procedure restored shoulder stability without significant impairment of shoulder function in patients with engaging Hill-Sachs lesions.
Purchase et al describe their arthroscopic technique for combined labral repair and Remplissage procedure to treat traumatic shoulder instability in patients with glenoid bone loss and a large Hill-Sachs lesion. The procedure consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon to fill the Hill-Sachs lesion first, followed by Bankart lesion repair.
Figure A shows a T2 axial MRI with a large Bankart tear and large Hill-Sachs lesion. Illustration A shows an example of arthroscopic labral repair and Remplissage technique.
Answer 1: No information given to suggest SLAP tear.
Answer 2: Bone grafting of the humeral head defect alone would not address the large Bankart lesion.
Answer 3: MRI is not consistent with a HAGL lesion.
Answer 4: Remplissage alone would not address the torn anterior Bankart tear.
Zhu YM, Lu Y, Zhang J, Shen JW, Jiang CY. Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up. Am J Sports Med. 2011 Aug;39(8):1640-7.
PMID:21505080 (Link to Abstract)
Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs ‘remplissage’: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2008 Jun;24(6):723-6.
PMID:18514117 (Link to Abstract)