Remplissage

 

Indications

 

Engaging Hill Sachs

 

Engaging Hill SachsEngaging Hill Sachs

 

Engaging Hill Sachs 1Engaging Hill Sachs 2

 

Technique

 

Tips

1.  Insert Hill Sachs anchors before performing bankart repair

- may be easier to do with humeral head subluxed over glenoid

- increases room to more

2.  May be best to clear subacromial space before inserting Hill Sachs anchors

 

Posterior portal glenohumeral jont

- camera anterior portal

- debride Hill Sachs

 

Hill Sachs DebridementRemplissage Anchors 1Remplissage Anchor 2

 

Insert 2 x anchors

- insert both via posterior portal

- leave one set of sutures out through portal

- separate stab incision posteriorly to retrieve other set of sutures into subacromial space

- use bird beaks or suture runner

 

Remplissage Anchors

 

Subacromial tying

- tip:  may be best to do this before passing anchors into Hill Sachs defect

- redirect posterior portal into subacromial space

- camera via lateral subacromial portal

- debride posterior subacromial space carefully to find sutures

- may want to place suture savers over sutures

 

Subacromial sutures

 

Knots

- separate with birds beak

- tie these knots (white) directly

 

Remplissage Subacromial Space

 

Knots / double pulley

- tie two limbs of separate anchors together

- use other limbs to oppose knots to tissue

- then tie other limbs

 

Remplissage Double PulleyRemplissage Subacromial Knots

 

Camera back into glenohumeral joint

- check capsule tied down into defect

 

Shoulder Post Remplissage