Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions

Abstract Hill-Sachs lesions are a common finding in patients with glenohumeral instability. There have been numerous methods described for addressing Hill-Sachs deformity. One popular method includes transferring a portion of the infraspinatus muscle into the posterior-superior defect (remplissage) to prevent the lesion from engaging and the resultant instability. We present a method of arthroscopic remplissage whereby the lesion is addressed through transtendinous insertion of arthroscopic anchors. Once 2 anchors have been inserted, 1 limb of each suture is tied to the other anchor, the so-called pulley repair technique. This can be performed either under direct visualization in the subacromial space or blindly while the surgeon is viewing from the articular side. Once both limbs have been tied, the infraspinatus tendon nicely spans the defect, and there has been minimal morbidity to the tendon itself. We have found this method to be useful for addressing a large Hill-Sachs deformity.