Editorial Commentary: For Shoulder Hill-Sachs Lesion Remplissage, Medial Anchor Position Must Be Optimized to Achieve Stability Yet Minimize External Rotation Loss

• Main Author: Ganokroj P.
• Other Authors: Mahidol University
• Format: Editorial
• Published: 2023
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/85411

An off-track Hill-Sachs lesion (HSL) is a significant risk factor for recurrent shoulder instability after arthroscopic Bankart repair. Bankart repair combined with remplissage can better restore shoulder stability versus isolated Bankart repair when treating a combined Bankart lesion and off-track HSL. However, remplissage may be nonanatomic and associated with limitation of shoulder external rotation (ER), especially when the arm is in a 90° shoulder abduction position. Excessive medial placement of remplissage anchors is associated with postoperative ER loss and increased glenohumeral cartilage degeneration. The use of 2 medial anchors results in lower articular forces. Thus, in patients with shoulder instability, we recommend using 2 remplissage anchors in those with a Bankart lesion plus an off-track HSL. The anchors should be placed medially to achieve stability—but not so medial as to result in postoperative stiffness and significant ER loss.