Arthroscopic Bone Graft Remplissage Using Flexible Bone Allograft for Treatment of Hill-Sachs Lesions in Anterior Shoulder Instability.

Hill-Sachs lesions are defects in the posterior humeral head from anterior glenoid impaction during dislocation. Left untreated, they can contribute to failure after arthroscopic Bankart repair. Arthroscopic remplissage, involving capsulotenodesis of the posterior capsule and infraspinatus tendon, is the most frequently performed approach to address this lesion. In this technical note, we describe a bone graft remplissage that augments the remplissage with the arthroscopic insertion of a flexible bone graft between the capsule and the sutures to fill the Hill-Sachs defect. Once secured, the graft is compressed into the defect to create a biological scaffold. This technique combines the simplicity of the knotless remplissage technique with the addition of structural bone graft to Hill-Sachs lesions.