Editorial Commentary: Preoperative 3-Dimensional Imaging for Shoulder Instability Is Vital for Determination of Off-Track Lesions and May Indicate Bankart Repair Plus Remplissage

The on- and off-track concept is gaining momentum for surgeons who treat patients with anterior shoulder instability. Preoperative imaging is critical for improving our outcomes. Determination of an off-track lesion prior to surgery using 3-dimensional computed tomography allows for improvement in outcomes by indicating remplissage. Intraoperative determination with the patient under anesthesia is not as good or as accurate. However, although Bankart repair plus remplissage shows good outcomes, bony procedures such as Latarjet, distal tibia allograft, and iliac crest or other bone graft procedures are preferred for large defects. Still, perhaps it is time to truly look at posterior adjuncts to anterior instability such as remplissage in patients who have off-track lesions, even with notable bipolar bone loss.