If you’ve experienced repeated shoulder dislocations, especially from the front (anterior instability), your surgeon may recommend a procedure called a remplissage. The term means “to fill in” in French, and that’s essentially what this surgery does—it fills in a bone defect in the back part of the upper arm bone (humerus) called a Hill-Sachs lesion.
When the shoulder dislocates, it can cause a dent in the humeral head. If that dent catches on the socket during movement, it can lead to repeated dislocations. Remplissage works by filling in that dent with tendon and muscle, reducing the chance of it engaging with the socket and causing another dislocation.
This procedure is often done alongside another common surgery called a Bankart repair, which fixes the torn cartilage in the front part of the shoulder.
Why Might You Need It?
After a traumatic dislocation, some patients develop a condition where the back of the humeral head gets damaged. This defect, called a Hill-Sachs lesion, can make the shoulder unstable. If this defect is large or located in a spot where it keeps hitting the socket edge, it’s considered “engaging.” Engaging lesions make it more likely for the shoulder to pop out again, even after a standard repair.
Doctors use remplissage to prevent this engagement. It’s most often recommended when:
- The glenoid (socket) bone is mostly intact (less than 20–25% missing)
- There is a significant or “engaging” Hill-Sachs lesion
- You are physically active and want to avoid recurrence
How Does It Work?
The remplissage procedure is performed arthroscopically, meaning it’s done through small incisions using a camera and instruments. During surgery:
- Your surgeon will first repair the front part of your shoulder (Bankart repair).
- Then, they will place sutures to attach a tendon from the back of your shoulder—the infraspinatus—and part of the joint capsule into the bone defect (Hill-Sachs lesion).
- This acts like a “patch” that blocks the defect from engaging with the front of the shoulder socket.
What to Expect After Surgery
Stability and Success Rates
According to clinical studies, over 94% of patients did not experience recurrent shoulder instability after this procedure. In fact, the remplissage significantly reduced the need for more surgery compared to patients who only had a Bankart repair.
Return to Sports
Most athletes—especially those in contact sports—were able to return to sports after remplissage. Of those who played sports before surgery, over 90% got back to some level of play, and about 70% returned to the same or higher level.
Pain and Complications
Pain typically improves after surgery, and complication rates are extremely low. Only a small number of patients (around 0.4%) experienced other issues like minor nerve irritation or biceps inflammation, both of which were treated successfully with conservative methods.
Will I Lose Shoulder Motion?
A concern for many patients is whether remplissage will reduce their shoulder movement—especially rotation.
Here’s what the evidence shows:
- The main area affected is external rotation (when you rotate your arm outward).
- Studies found a mild loss of external rotation, usually about 9 to 14 degrees when compared to the other shoulder.
- However, this difference is often not noticeable in everyday activities.
- There is no major loss in overhead movement or internal rotation (bringing your arm inward).
Athletes who rely on overhead throwing, such as baseball pitchers, should discuss this potential trade-off with their surgeon.
How Is It Different from Other Procedures?
There are two main alternatives:
- Isolated Bankart Repair: Less invasive but higher risk of re-dislocation in patients with bone defects.
- Latarjet Procedure: Often used for patients with greater socket bone loss, but carries a higher risk of complications.
Compared to these, remplissage offers a middle ground:
- Lower recurrence than Bankart alone
- Fewer complications than Latarjet
- Excellent stability in properly selected patients
What About the Long-Term?
The follow-up period in most studies ranged from 6 months to 15 years. Long-term outcomes show continued shoulder stability, improved quality of life, and low need for additional surgery.
However, studies also show the need for more high-quality research with consistent outcome reporting. Because many studies are retrospective, large-scale prospective trials are still needed to confirm the best patient selection and long-term outcomes.
Key Takeaways for Patients
- Remplissage is a safe and effective procedure that helps stabilize the shoulder in patients with bone damage after dislocation.
- It is most commonly used when there is moderate humeral bone loss but little socket bone loss.
- Most patients return to sports and daily life with little to no pain and good shoulder motion.
- There may be a small decrease in shoulder rotation, especially outward rotation, but for most patients, this has no meaningful impact.
- Serious complications are rare.
Is Remplissage Right for You?
If you’ve had repeated shoulder dislocations and imaging shows an engaging Hill-Sachs lesion, your surgeon may recommend remplissage as part of your surgical plan. It’s especially useful if:
- You’ve failed non-surgical treatments or prior surgeries
- You’re an athlete at risk of reinjury
- You want a less invasive option than bone-block procedures like Latarjet
Always discuss your activity level, goals, and imaging results with your surgeon to find the most appropriate treatment plan.
Do you have more questions?
Q. What is the remplissage procedure used to treat?
A. The remplissage procedure is used to treat recurrent shoulder dislocations, particularly when there is a Hill-Sachs lesion associated with anterior shoulder instability.
Q. What is a Hill-Sachs lesion?
A. A Hill-Sachs lesion is a compression fracture of the posterior aspect of the humeral head that occurs when the shoulder dislocates anteriorly.
Q. How does a Hill-Sachs lesion contribute to shoulder instability?
A. A Hill-Sachs lesion can engage with the anterior edge of the glenoid during shoulder movement, increasing the risk of repeated dislocations.
Q. How does the remplissage procedure work?
A. The remplissage procedure involves filling the Hill-Sachs defect with soft tissue, typically by attaching the posterior capsule and infraspinatus tendon into the lesion to prevent it from engaging the glenoid.
Q. Is remplissage performed alone or with other procedures?
A. It is often performed in conjunction with a Bankart repair to address both soft tissue and bony causes of instability.
Q. What are the benefits of adding remplissage to Bankart repair?
A. Adding remplissage decreases the recurrence rate of shoulder dislocations in patients with engaging Hill-Sachs lesions.
Q. How is the remplissage procedure performed?
A. It is usually performed arthroscopically, using small incisions and specialized instruments to place anchors and suture the soft tissue into the humeral head defect.
Q. What type of anesthesia is used for the remplissage procedure?
A. The procedure is generally done under general anesthesia, often combined with a nerve block for postoperative pain control.
Q. What is the typical recovery time after remplissage surgery?
A. Recovery can take several months, with immobilization initially followed by physical therapy to restore range of motion and strength.
Q. Will remplissage affect shoulder motion?
A. Some patients may experience a slight decrease in external rotation due to the infraspinatus being used in the repair.
Q. Who is a good candidate for the remplissage procedure?
A. Patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion are typically good candidates for this procedure.
Q. What imaging studies are used to assess the need for remplissage?
A. MRI and CT scans can help evaluate the size and location of the Hill-Sachs lesion to determine if it is engaging and warrants remplissage.
Q. Is remplissage considered a reliable solution for shoulder instability?
A. Yes, especially when combined with Bankart repair, it has shown good outcomes in reducing recurrence of dislocations.
