Arthroscopic Bankart Repair with Remplissage

Overview

Arthroscopic Bankart repair reattaches the torn labrum to the front of the shoulder socket after a dislocation. Remplissage ("to fill") adds a step: tenodesing the infraspinatus tendon into the Hill-Sachs defect on the humeral head so it can no longer catch the socket edge and cause redislocation. Dr. Raffo adds remplissage selectively, based on bone anatomy, not routinely.

How Dr. Raffo Performs This Procedure

Bankart repair with remplissage is performed arthroscopically through small shoulder portals, typically as a single combined procedure:

1. The torn anterior labrum is identified and mobilized off the glenoid neck.
2. Suture anchors are placed along the anterior glenoid rim, and the labrum and capsule are repaired back to bone, restoring the labral "bumper" that normally deepens the socket.
3. The Hill-Sachs defect on the back of the humeral head is identified and assessed against the glenoid track.
4. If the lesion is off-track, one or two additional suture anchors are placed into the floor of the Hill-Sachs defect, and the infraspinatus tendon and posterior capsule are tenodesed into the defect, filling it so it cannot engage the glenoid edge during abduction and external rotation.
5. Portals are closed and the arm is placed in a sling.

Who Is This For?

Bankart repair with remplissage is directed at a specific anatomic picture, not simply "anyone with a shoulder dislocation":

• Patients with recurrent anterior instability and an off-track Hill-Sachs lesion — a humeral-head defect large enough, relative to the glenoid, to engage the socket edge during normal arm positions.
• Patients with subcritical glenoid bone loss, generally in the range where a Bankart repair alone is not reliable but a bone-block procedure is more than the anatomy requires.
• Athletes and active patients who want the lowest-morbidity operation that still meaningfully reduces redislocation risk, understanding the tradeoffs discussed below.

It is not the right operation for every unstable shoulder. Patients whose glenoid bone loss is the dominant lesion — rather than the humeral side — are usually better served by a bone-block procedure such as Latarjet, discussed under "Where Surgeons Disagree" below and on the shoulder instability hub. Overhead throwing athletes, for whom even small losses of terminal external rotation may matter more than the pooled data suggest, are a group Dr. Raffo counsels individually.

Recovery & Rehabilitation

Recovery from Bankart repair with remplissage follows the same broad arc as isolated Bankart repair, with attention to protecting both the anterior repair and the posterior tenodesis.

• 0–4 weeks: Sling immobilization; passive range of motion only, as directed.
• 4–8 weeks: Progressive active-assisted and active motion.
• 8–12 weeks: Strengthening begins, with attention to regaining external rotation.
• 4–6 months: Sport-specific training and return-to-throwing or return-to-contact progression, if applicable.
• 6–9 months: Return to full contact sport or unrestricted overhead activity, timed individually; meta-analysis puts mean return to sport around 7 months (Garcia, AJSM 2016).