Double-blind RCT comparing arthroscopic Bankart repair alone versus Bankart plus infraspinatus remplissage in 108 patients with recurrent anterior shoulder instability. All patients had an engaging Hill-Sachs lesion of any size and glenoid bone loss under 15%. The study asks whether remplissage reduces re-dislocation without sacrificing functional outcomes at two years.
Before this RCT, the decision to add remplissage was based on retrospective series and biomechanical data — no Level I evidence existed to guide the choice. The concern was that tethering the infraspinatus into the defect might sacrifice external rotation and sport function in exchange for stability, making surgeons hesitant to adopt it routinely.
This trial changes the calculus directly. When you see anterior instability with an engaging Hill-Sachs lesion and glenoid bone loss under 15%, add remplissage: it cuts re-dislocation from 18% to 4% and eliminates revision surgery, with no measurable functional cost at two years. For lesions meeting the high-risk threshold (width ≥20 mm or depth ≥15% of humeral head diameter), the case is even stronger. The odds of re-dislocation without remplissage are 11.5 times higher.
One nuance worth knowing: the ~10° external rotation loss at 12 months resolves by 24 months in the general population, but prior data cited by the authors suggest even 5° of loss may impair overhead throwers. In that specific group, counsel carefully and consider whether remplissage or an alternative bony procedure better fits the demand.
Arthroscopic Bankart Repair with and without Arthroscopic Infraspinatus Remplissage in Anterior Shoulder Instability with a Hill-Sachs Defect: a Randomized Controlled Trial
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Double-blind RCT comparing arthroscopic Bankart repair alone versus Bankart plus infraspinatus remplissage in 108 patients with recurrent anterior shoulder instability. All patients had an engaging Hill-Sachs lesion of any size and glenoid bone loss under 15%. The study asks whether remplissage reduces re-dislocation without sacrificing functional outcomes at two years.
Before this RCT, the decision to add remplissage was based on retrospective series and biomechanical data — no Level I evidence existed to guide the choice. The concern was that tethering the infraspinatus into the defect might sacrifice external rotation and sport function in exchange for stability, making surgeons hesitant to adopt it routinely.
This trial changes the calculus directly. When you see anterior instability with an engaging Hill-Sachs lesion and glenoid bone loss under 15%, add remplissage: it cuts re-dislocation from 18% to 4% and eliminates revision surgery, with no measurable functional cost at two years. For lesions meeting the high-risk threshold (width ≥20 mm or depth ≥15% of humeral head diameter), the case is even stronger. The odds of re-dislocation without remplissage are 11.5 times higher.
One nuance worth knowing: the ~10° external rotation loss at 12 months resolves by 24 months in the general population, but prior data cited by the authors suggest even 5° of loss may impair overhead throwers. In that specific group, counsel carefully and consider whether remplissage or an alternative bony procedure better fits the demand.