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| Hill Sachs lesion at the posterior superior aspect of the shoulder |
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| Placement of anchor and reimplassage |
In French reimplassage means "to fill in". During this procedure the engaging Hill Sachs lesion of the humeral defect is filled in the infraspinatus tendon and the capsule. The Hill Sachs lesion is converted to an extra-articular lesion that does not engage with the anterior glenoid rim providing stability to the shoulder. The procedure was described in 2007 by Wolf et al as an adjunct to the arthroscopic anterior stabilisation procedure of the shoulder in order to address a large engaging Hill-Sach's defect.
It is ideally suited to instability patients who have large, engaging Hill-Sachs lesions and soft-tissue Bankart tears. These patients are known to have a higher failure rate after surgery than those with smaller lesions. The results of this technique in this difficult subset of traumatic anterior shoulder instability patients are significantly better (10% recurrence rate) than with an arthroscopic Bankart repair alone (67% recurrence rate).
The following case is a patient is his 20s who had 30 dislocations during the past 6 years. His first traumatic anterior shoulder dislocation was a result of a wrestling accident. Due to his young age and no bone loss at the glenoid side we elected to proceed with an arthroscopic Bankart repair combined with a reimplassage procedure due to the large engaging Hill Sachs lesion. Imaging studies and arthroscopy pictures are shown below.
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| Grashey view |
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| Apical oblique shows no glenoid bone loss |
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| Bankart lesion; view from anterior and posterior portal |
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| Repaired Bankart |
