A Hill-Sachs lesion (orange dashed line) is shown on this MRI image of the shoulder. This MRI view shows the shoulder joint in cross-section, with the front of the shoulder at the top of the image and the back of the shoulder at the bottom.
When the shoulder dislocates, the back of the humeral head (ball) impacts the front rim of the glenoid (socket). In some cases, this results in an impaction fracture in the back of the humeral head, called a Hill-Sachs lesion. A Hill-Sachs lesion looks like a divot in the normally smooth round surface of the humeral head (see figure). Hill-Sachs lesions, if large, can increase the risk of recurrent dislocation unless properly treated.
Remplissage is a French word meaning to fill. It is a minimally invasive arthroscopic procedure in which soft tissue in the back of the shoulder (rotator cuff and capsule) are sewn into the floor of the Hill-Sachs lesion. This effectively removes the Hill-Sachs lesion from the joint and eliminates it as a potential cause of recurrent dislocations.
Arthroscopic remplissage is often combined with arthroscopic Bankart repair. Remplissage is also an outpatient procedure. Patients go home the same day with a shoulder immobilizer sling. The sling is worn for 4-6 weeks, but may be removed for bathing and physical therapy. Most patients are cleared to return to sports by 6 months after surgery.