Best Remplissage Surgery in Lucknow by Expert Arthroscopic Surgeon

Shoulder instability can make simple tasks like lifting, throwing, or even reaching overhead painful and unpredictable. For those with recurrent shoulder dislocations or Hill-Sachs lesions, remplissage surgery offers a transformative solution to restore stability and function. This minimally invasive procedure, performed by skilled arthroscopic and sports injury surgeon Dr. Saurabh Jain, addresses shoulder defects with precision, helping patients regain confidence in their daily activities. Here we will talk about remplissage surgery, its benefits, procedure details, and recovery, emphasizing advanced techniques like the keyhole procedure to fill shoulder defect to ensure lasting shoulder health for athletes, professionals, and active individuals.

What Is Remplissage Surgery?

Remplissage surgery is an arthroscopic procedure designed to treat shoulder instability caused by a Hill-Sachs lesion—a bony defect in the humeral head resulting from anterior shoulder dislocations. The term "remplissage," French for "filling," describes the process of filling this defect with soft tissue, typically the infraspinatus tendon and posterior capsule, to prevent the lesion from engaging with the glenoid (shoulder socket). This shoulder stability surgery with tendon filling converts the intra-articular defect into an extra-articular one, enhancing joint stability. Performed using small incisions and a camera-guided arthroscope, the arthroscopic remplissage procedure minimizes tissue damage, speeds recovery, and reduces scarring compared to open surgery. It is often combined with a Bankart repair, which fixes anterior labral tears, to address both soft tissue and bony causes of instability. This combined approach is ideal for patients with recurrent dislocations or large, engaging Hill-Sachs lesions, ensuring precision and long-term shoulder stability.

Causes and Symptoms of Shoulder Instability and Hill-Sachs Lesions

Shoulder instability occurs when the humeral head slips out of the glenoid, often due to trauma or repetitive stress. Hill-Sachs lesions form when the humeral head impacts the glenoid rim during a dislocation, creating a dent that increases the risk of further instability. These conditions are common among athletes in high-contact sports, swimmers, or individuals performing repetitive overhead tasks. Anatomical predispositions, such as loose ligaments or shallow sockets, can also contribute to instability. Symptoms vary depending on severity. Acute dislocations cause immediate sharp pain and a visible shoulder deformity, often followed by weakness. Recurrent instability leads to discomfort, a sensation of slipping, and difficulty with overhead or rotational movements. Chronic instability may hinder daily activities such as reaching, lifting, or sports performance.

Common Causes

• Trauma: Falls, direct blows, or sports-related accidents.
• Repetitive Stress: Overhead activities like swimming, throwing, or lifting.
• Anatomical Factors: Loose ligaments, shallow glenoid sockets, or previous dislocations.

Recognizing Symptoms

• Pain and Discomfort: Sharp pain during movement or after dislocations.
• Instability: A feeling of the shoulder slipping or giving way.
• Reduced Mobility: Difficulty with overhead or rotational tasks.

Early recognition and treatment are essential to prevent chronic instability and long-term joint damage.

Diagnosis of Shoulder Instability and Hill-Sachs Lesions

Diagnosing shoulder instability and Hill-Sachs lesions involves clinical evaluation and imaging. A detailed history identifies the injury’s cause, such as a fall or repetitive overhead motions. Physical exams, like the anterior load-and-shift test, assess joint laxity, while the apprehension test checks for instability during external rotation.

Physical Examination

Tests like the pivot shift or sulcus sign evaluate the shoulder’s stability and range of motion. Palpation detects tenderness, and functional tests reveal limitations. These non-invasive methods provide critical insights into the injury’s severity.

Imaging Tests

• MRI: Visualizes soft tissues and confirms Hill-Sachs lesions with 90% accuracy.
• CT: Assesses bony defects and glenoid bone loss.
• X-rays: Rules out fractures or dislocations.

Accurate diagnosis guides whether repair for shoulder socket indentation is needed, ensuring a tailored treatment plan.

Treatment Options for Shoulder Instability

Treatment depends on the extent of instability, lesion size, and patient activity level. Non-surgical options suit mild cases, while remplissage surgery is recommended for significant Hill-Sachs lesions or recurrent dislocations.

Non-Surgical Treatments

Non-surgical approaches include physical therapy to strengthen rotator cuff muscles and improve stability. Bracing limits harmful movements, and rest with anti-inflammatory measures reduces swelling. This approach works for 40-60% of patients with minor instability but is less effective for large lesions.

Surgical Treatments

For recurrent instability or engaging Hill-Sachs lesions, the arthroscopic remplissage procedure is highly effective. It involves infraspinatus tenodesis with capsulodesis, where the tendon and capsule are anchored into the defect. Often paired with Bankart repair, this soft tissue patching for unstable shoulder prevents the lesion from engaging the glenoid, reducing dislocation risk.

The Remplissage Surgery Procedure

Remplissage surgery begins with pre-operative planning to ensure optimal outcomes. Patients undergo imaging and physical assessments to confirm the need for arthroscopic Hill-Sachs defect filling technique. During surgery, small incisions allow the arthroscope and instruments to access the shoulder joint. The Hill-Sachs lesion is prepared, and the infraspinatus tendon and posterior capsule are sutured into the defect using anchors, creating a stable, extra-articular surface.

Post-operative care focuses on protecting the repair and initiating early rehabilitation. Most patients are discharged the same day, thanks to the minimally invasive nature of keyhole shoulder stabilization (defect filling technique).

Pre-Operative Preparation

Patients are advised to strengthen shoulder muscles pre-operatively to aid recovery. Medical history is reviewed, and anesthesia options (general or regional) are discussed to minimize risks.

The Surgery Step by Step

• Anesthesia: Administered for comfort.
• Arthroscopy: Small incisions for camera and tools.
• Lesion Preparation: Hill-Sachs defect is debrided for optimal healing.
• Tendon Fixation: Infraspinatus and capsule anchored into the defect.
• Closure: Incisions sutured, shoulder bandaged.

This arthroscopic posterior capsule–infraspinatus repair ensures precise defect filling.

Post-Operative Care

Immediate care includes sling immobilization for 4-6 weeks and pain management. Gentle range-of-motion exercises begin early to prevent stiffness, with follow-ups to monitor healing.

Benefits of Remplissage Surgery

Remplissage surgery offers significant advantages for shoulder instability. The soft-tissue filling of Hill-Sachs lesion reduces dislocation risk by up to 95% when combined with Bankart repair. Small incisions minimize scarring, pain, and infection risk, with patients resuming light activities within weeks. The procedure restores long-term stability, ideal for athletes or workers with repetitive shoulder demands.

The keyhole shoulder stabilization (defect filling technique) preserves shoulder anatomy while enhancing function, allowing patients to return to sports or daily tasks with confidence.

Recovery and Rehabilitation After Surgery

Recovery from remplissage surgery follows a phased approach, with sling use for 4-6 weeks to protect the repair. Physical therapy starts within days, focusing on passive motion to maintain flexibility. Strength training begins at 6-8 weeks, progressing to functional exercises by 12 weeks. Full return to high-impact activities takes 4-6 months.

Rehabilitation emphasizes rotator cuff strengthening and proprioception to restore stability. Patients are guided to avoid premature overhead motions to protect the infraspinatus tenodesis with capsulodesis.

Immediate Post-Surgery Phase

Sling immobilization and ice reduce swelling. Gentle finger and wrist movements prevent stiffness, and pain is managed with prescribed methods.

Physical Therapy and Rehab

Therapy progresses from passive motion to active exercises, targeting rotator cuff and deltoid strength. Balance training enhances joint control, with sport-specific drills for athletes.

Timeline for Return to Activities

• 1-4 Weeks: Sling use, passive motion.
• 6-8 Weeks: Active motion, light strengthening.
• 12-16 Weeks: Functional exercises.
• 4-6 Months: Return to sports or heavy lifting.

This timeline ensures safe recovery.

Risks and Complications

Risks include stiffness (10-15% of cases), particularly in external rotation, and rare instances of infection or anchor failure. Recurrent instability is uncommon (<5% with Bankart repair). Adhering to rehab protocols minimizes these risks, ensuring optimal outcomes.

Remplissage surgery is a highly effective solution for shoulder instability and Hill-Sachs lesions, offering lasting stability through soft-tissue filling of Hill-Sachs lesion. This minimally invasive approach, performed with arthroscopic posterior capsule–infraspinatus repair, ensures quick recovery and minimal complications, ideal for active individuals. With expert care, patients can regain shoulder function and confidence.

Dr. Saurabh Jain, Arthroscopic and Sports Injury Surgeon in Lucknow