The Remplissage procedure is a surgical technique used to treat recurrent shoulder instability, a condition where the shoulder joint repeatedly dislocates or partially dislocates. The term “Remplissage” is French for “to fill,” which describes the goal of the surgery: to fill a specific defect in the upper arm bone. This technique is almost always performed as a supplement to other shoulder stabilization surgeries, most commonly a Bankart repair. By treating this defect, the procedure addresses a complex injury type that increases the risk of future dislocations and significantly lowers the chance of the shoulder becoming unstable again.
The Context: Why Remplissage is Necessary
The need for Remplissage arises from a specific injury known as a Hill-Sachs lesion. This lesion is a compression fracture or defect on the back (posterosuperior) aspect of the humeral head, the ball of the shoulder joint. It forms when the front of the shoulder dislocates, causing the humeral head to impact forcefully against the front rim of the shoulder socket (glenoid).
Remplissage is indicated when the lesion is deemed “engaging,” meaning it catches the glenoid rim as the arm moves into positions of risk, such as overhead or in external rotation. This engagement acts like a lever, forcing the shoulder out of the socket and leading to recurrent instability.
Remplissage is typically chosen when the Hill-Sachs defect is moderate to large, or when the patient has experienced repeated dislocations. Performing only a standard Bankart repair may not be sufficient, leading to a higher rate of failure. By addressing both the Bankart tear and the Hill-Sachs lesion, the Remplissage technique provides a more comprehensive solution for shoulder stability.
How the Remplissage Procedure Works
The Remplissage procedure is performed arthroscopically, meaning the surgeon uses small incisions and a camera to visualize the inside of the shoulder joint. The process begins with the surgeon identifying the Hill-Sachs defect on the back of the humeral head. To prepare the site for healing, the surgeon uses a burr to lightly abrade the bone surface within the defect.
Next, specialized suture anchors are placed directly into the prepared bone of the Hill-Sachs defect. Each anchor contains strong sutures used to secure the soft tissues. The sutures are then carefully passed through the adjacent posterior cuff tissue, which includes the joint capsule and the infraspinatus tendon. The infraspinatus is one of the muscles that make up the rotator cuff, located directly behind the shoulder joint.
The surgeon then tightens and secures these sutures, which pulls the capsule and the infraspinatus tendon directly into the bone defect. This action effectively “fills” the dent with soft tissue, which is the exact mechanism that gives the procedure its French name. By filling the defect, the procedure converts the lesion from an intra-articular defect—one inside the joint that can engage the socket—to an extra-articular one.
Once filled, the soft tissue acts as a biological block, preventing the humeral head defect from engaging or catching on the anterior glenoid rim during movement. This tenodesis, or anchoring of the tendon into the bone, limits the degree of external rotation the shoulder can achieve in the abducted position. This restriction is intentional, as it eliminates the movement combination that previously caused the shoulder to dislocate.
Immediate Post-Operative Care and Recovery
Following the Remplissage procedure, post-operative care focuses on pain management and protecting the surgical repair site. Patients are typically placed in an arm immobilization sling, which must be worn full-time for an initial period, often lasting four to six weeks. This immobilization is crucial because it allows the tendon and capsule anchored into the bone to heal securely, a process that relies on minimal movement.
During the initial phase of recovery, patients are restricted to passive range of motion exercises, meaning the arm is moved by a therapist or the patient’s opposite hand, without contracting the repaired shoulder muscles. Gentle hand, wrist, and elbow movements are encouraged early on to prevent stiffness and promote circulation. Strengthening exercises are avoided for the first two to three months to protect the integrity of the tendon-to-bone repair.
A common side effect of the Remplissage procedure is a temporary or slight permanent loss of external rotation. This occurs because the infraspinatus tendon, which is responsible for external rotation, has been anchored into the humeral head. Physical therapy plays a significant role in managing this, gradually reintroducing external rotation to prevent excessive stiffness without compromising the surgical repair.
The full rehabilitation process is progressive, moving from passive motion to active-assisted motion around four to eight weeks, and then to active range of motion. Strengthening typically begins around three months post-surgery, focusing on the rotator cuff and scapular muscles. A return to light daily activities, such as desk work, may occur within one to two weeks, but a return to contact sports or heavy manual labor often takes six months or more to ensure full strength and healing.