Shoulder remplissage is a surgical procedure designed to treat recurrent shoulder dislocations, particularly those caused by bone defects on the back side of the upper arm bone (humerus) known as Hill-Sachs lesions. The term “remplissage” means “to fill in” in French, and the procedure quite literally fills in the defect with tendon and capsule tissue to prevent further dislocations. It is often performed alongside a Bankart repair, which repairs the torn cartilage at the front of the shoulder joint.
How Common It Is and Who Gets It? (Epidemiology)
Shoulder instability is a common problem among athletes and physically active individuals, especially in young men under 30. Recurrent dislocations are often anterior (from the front) and can lead to bone loss on either the socket (glenoid) or humeral head. The remplissage procedure has become increasingly common over the last decade as a reliable method to stabilize the shoulder when bone defects are present. It is most frequently used in people who have had multiple anterior dislocations but still have relatively healthy glenoid bone.
Why It Happens – Causes (Etiology and Pathophysiology)
When the shoulder dislocates, the humeral head can strike the front edge of the socket, creating a dent in the back of the bone called a Hill-Sachs lesion. This defect can engage with the socket during movement, causing the shoulder to repeatedly slip out of place. If the glenoid (socket) bone remains mostly intact and the Hill-Sachs lesion is “engaging,” remplissage helps prevent the defect from catching on the socket rim. This is particularly useful for athletes or patients who need to avoid the higher complication rates of bone-grafting procedures like Latarjet.
How the Body Part Normally Works? (Relevant Anatomy)
The shoulder is a ball-and-socket joint made up of the humeral head (ball) and the glenoid (socket). Stability depends on a combination of the joint capsule, ligaments, and the rotator cuff muscles that keep the humeral head centered during motion. When a Hill-Sachs defect forms, the ball is no longer perfectly round, and it can “catch” on the edge of the socket, leading to repeated dislocations. The remplissage procedure fills in this defect using soft tissue, restoring smoothness and reducing instability.
What You Might Feel – Symptoms (Clinical Presentation)
Patients who may need remplissage often report:
- Shoulder instability or a sensation of the joint “slipping out”
- Pain with throwing, reaching, or overhead activities
- Repeated anterior shoulder dislocations
- Decreased confidence or strength in the shoulder
- Limited motion following previous dislocations
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis begins with a physical exam to assess range of motion and stability. Imaging studies are crucial to determine the extent of bone loss.
- X-rays can show the Hill-Sachs defect and overall joint alignment.
- MRI helps visualize the capsule, rotator cuff, and labrum.
- CT scans provide precise measurements of bone loss and help identify whether the lesion is engaging.
These tests guide the surgeon in determining whether remplissage, with or without a Bankart repair, is the most appropriate treatment.
Procedure Types or Techniques (Classification)
Remplissage is typically performed arthroscopically, using small incisions and a camera to visualize the joint. It is often done in combination with a Bankart repair, which addresses the torn front cartilage of the shoulder.
Surgical Steps:
- The surgeon begins by performing the Bankart repair to restore the torn anterior capsule.
- Next, sutures are passed into the posterior shoulder capsule and infraspinatus tendon.
- These sutures are anchored into the Hill-Sachs defect, effectively “filling” it with soft tissue.
- This creates a stable surface that prevents engagement of the defect with the glenoid during motion.
This combined procedure addresses both the soft tissue tear in front and the bone defect in back, providing dual stabilization for the shoulder.
Other Problems That Can Feel Similar (Differential Diagnosis)
Other causes of shoulder pain and instability that may mimic the need for remplissage include:
- Isolated Bankart lesions (cartilage tears without bone defects)
- Posterior instability or labral tears
- Multidirectional instability from ligament laxity
- Rotator cuff tears or impingement
- Shoulder arthritis or bony Bankart fractures
Accurate imaging helps differentiate these conditions and ensures the correct treatment plan.
Treatment Options
Treatment for recurrent shoulder instability may include:
- Physical therapy: Strengthening the rotator cuff and scapular muscles to improve stability.
- Arthroscopic Bankart repair: Reattaching the torn anterior labrum to restore stability.
- Remplissage: Filling the Hill-Sachs lesion to prevent engagement.
- Latarjet procedure: Used when there is significant bone loss on the socket side.
Remplissage is typically recommended when there is a significant humeral bone defect but the glenoid bone is still mostly intact.
Recovery and What to Expect After Surgery
Recovery after remplissage follows a structured rehabilitation plan:
- Weeks 0–4: The shoulder is immobilized in a sling. Only gentle pendulum movements are allowed.
- Weeks 4–6: The sling is removed, and active-assisted motion begins.
- Weeks 6–12: Gradual strengthening exercises are started, focusing on the rotator cuff and scapular stabilizers.
- After 4 months: Return to sports or higher-level activities is usually permitted, depending on progress.
Most patients regain excellent stability and function within six months.
Possible Risks or Side Effects (Complications)
Remplissage has a very low complication rate. Potential risks include:
- Mild loss of external rotation (average 9–14°)
- Rare nerve irritation or biceps tendon inflammation
- Stiffness if rehabilitation is delayed
- Rare cases of recurrent instability
Overall, serious complications are uncommon, and most patients achieve lasting shoulder stability.
Long-Term Outlook (Prognosis)
Remplissage has excellent success rates, with more than 94% of patients avoiding recurrent dislocations. Over 90% of athletes return to sports, and about 70% return to their previous level of performance. Long-term studies (up to 15 years) show continued stability, good range of motion, and improved quality of life.
Out-of-Pocket Cost
Medicare
CPT Code 29806 – Arthroscopic Bankart Repair with Remplissage (Shoulder Stabilization for Anterior Instability): $250.66
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce patient financial responsibility.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range between $100 and $300, depending on your plan and provider network.
Workers’ Compensation
If your Bankart repair with remplissage is required due to a work-related injury, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly pays for all approved treatments.
No-Fault Insurance
If your shoulder dislocation or instability requiring Bankart repair with remplissage is the result of an automobile accident, No-Fault Insurance will typically cover the full cost of your treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment, depending on your insurance policy.
Example
James Miller suffered from recurrent shoulder dislocations and underwent an arthroscopic Bankart repair with remplissage (CPT 29806). His estimated Medicare out-of-pocket cost was $250.66. Since James had supplemental insurance through AARP Medigap, his remaining balance was fully covered, leaving him with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is the remplissage procedure used to treat?
A. The remplissage procedure is used to treat recurrent shoulder dislocations, particularly when there is a Hill-Sachs lesion associated with anterior shoulder instability.
Q. What is a Hill-Sachs lesion?
A. A Hill-Sachs lesion is a compression fracture of the posterior aspect of the humeral head that occurs when the shoulder dislocates anteriorly.
Q. How does a Hill-Sachs lesion contribute to shoulder instability?
A. A Hill-Sachs lesion can engage with the anterior edge of the glenoid during shoulder movement, increasing the risk of repeated dislocations.
Q. How does the remplissage procedure work?
A. The remplissage procedure involves filling the Hill-Sachs defect with soft tissue, typically by attaching the posterior capsule and infraspinatus tendon into the lesion to prevent it from engaging the glenoid.
Q. Is remplissage performed alone or with other procedures?
A. It is often performed in conjunction with a Bankart repair to address both soft tissue and bony causes of instability.
Q. What are the benefits of adding remplissage to Bankart repair?
A. Adding remplissage decreases the recurrence rate of shoulder dislocations in patients with engaging Hill-Sachs lesions.
Q. How is the remplissage procedure performed?
A. It is usually performed arthroscopically, using small incisions and specialized instruments to place anchors and suture the soft tissue into the humeral head defect.
Q. What type of anesthesia is used for the remplissage procedure?
A. The procedure is generally done under general anesthesia, often combined with a nerve block for postoperative pain control.
Q. What is the typical recovery time after remplissage surgery?
A. Recovery can take several months, with immobilization initially followed by physical therapy to restore range of motion and strength.
Q. Will remplissage affect shoulder motion?
A. Some patients may experience a slight decrease in external rotation due to the infraspinatus being used in the repair.
Q. Who is a good candidate for the remplissage procedure?
A. Patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion are typically good candidates for this procedure.
Q. What imaging studies are used to assess the need for remplissage?
A. MRI and CT scans can help evaluate the size and location of the Hill-Sachs lesion to determine if it is engaging and warrants remplissage.
Q. Is remplissage considered a reliable solution for shoulder instability?
A. Yes, especially when combined with Bankart repair, it has shown good outcomes in reducing recurrence of dislocations.
Summary and Takeaway
The remplissage procedure is a safe and effective solution for recurrent shoulder instability caused by Hill-Sachs lesions. It reduces the risk of future dislocations by filling in the bone defect with soft tissue while preserving most shoulder motion. For athletes and active patients with minimal glenoid bone loss, it provides excellent stability with low complication rates and a high return-to-sport success.
Clinical Insight & Recent Findings
A recent study published in Current Reviews in Musculoskeletal Medicine reviewed the role of remplissage as an adjunct to arthroscopic Bankart repair for anterior shoulder instability with Hill-Sachs lesions, concluding that the procedure markedly lowers recurrence rates while maintaining near-normal shoulder motion.
The meta-analyses cited showed recurrence rates of just 3–4% with remplissage versus 16–18% after Bankart repair alone, without any meaningful loss in external rotation or function. Patients experienced high satisfaction and over 90% returned to sports, although overhead athletes occasionally reported mild difficulty with throwing.
Compared with the Latarjet procedure, remplissage achieved similar long-term stability but with fewer complications, making it an effective, minimally invasive option for patients with moderate humeral bone loss and intact glenoid structure. (“Study of remplissage for anterior shoulder instability – see PubMed.“)
Who Performs This Surgery? (Specialists and Team Involved)
Remplissage is performed by orthopedic surgeons specializing in shoulder and sports medicine. The surgical team includes anesthesiologists, physician assistants, nurses, and physical therapists who coordinate care before and after surgery.
When to See a Specialist?
If you’ve experienced multiple shoulder dislocations, persistent instability, or pain after previous shoulder surgery, it’s time to consult a shoulder specialist for an evaluation.
When to Go to the Emergency Room?
Seek emergency care if your shoulder dislocates and does not return to place easily, or if you develop severe pain, swelling, or numbness after surgery.
What Recovery Really Looks Like?
Recovery involves progressive rehabilitation, starting with protection in a sling and advancing to motion and strengthening over several months. By four to six months, most patients regain strength and stability and resume full activities.
What Happens If You Delay Surgery?
Delaying remplissage can lead to repeated dislocations, further cartilage and bone damage, and increased risk of arthritis. Early surgical stabilization helps prevent these long-term issues.
How to Prevent Recurrence or Failure?
Adhering to the prescribed physical therapy plan, avoiding early stress on the shoulder, and maintaining strength in the rotator cuff and shoulder blade muscles are key to long-term success.
Nutrition and Bone or Joint Health
A balanced diet rich in calcium, vitamin D, and protein supports bone and soft tissue healing. Avoid smoking and maintain good hydration to enhance recovery.
Activity and Lifestyle Modifications
After recovery, most patients can safely return to normal activities and sports. Avoid high-risk movements such as excessive overhead throwing until cleared by your surgeon. With proper care, remplissage provides lasting stability and pain-free shoulder motion.
