We describe the treatment of traumatic anterior shoulder instability complicated with Hill-Sachs lesion, using a combined arthroscopic technique of anterior & posterior capsular fixation and infraspinatus tenodesis by means of suture-anchors, in order to fill the humeral head bone defect (i.e. “remplissage”).

We use 2 posterior portals introducing the arthro-scope through the upper one. A double-armed suture-anchor is inserted through each portal piercing the infranspinatous tendon & posterior capsule in an extra-articular mattress mode. The humeral head bone defect is filled with the aforementioned tissues.

18 patients with well established anterior instability were subject to this technique between March 2005 and December 2008. The follow-up time was 6 to 36 months (average 18 months). All were evaluated using the Rowe protocol for shoulder instability which assess stability, ROM & shoulder functionality.

In 13 patients the outcome was assessed as excellent, in 4 good & in 1 average. In one patient, post-op stiffness was developed which managed successfully with conservative means.

The arthroscopic technique of “remplissage” is an innovative choice in the armamentarium of treatment of anterior traumatic instability with concomitant Hill-Sachs lesion. The results of this technique are excellent regarding the recurrence rate of anterior instabiliy (in our series there was none episode of recurrent instability during the study period).

Aim: The detachment of superior glenoid labrum extending anterior and posterior (SLAP) is a traumatic condition which is just recently recognized as an important source of shoulder pain and dysfunction. This lesion can occur isolated or in association with other pathologic entities such as: impingement syndrome, rotator cuff ruptures and instability. The diagnosis with clinical examination, simple x-rays and MRI is difficult and it can be established only arthroscopicaly. The aim of this study is to present the technique and the results of the arthroscopic labral reattachment and also to point out the necessity of treatment especially in the coexistence with other pathologies.

Method: 7 patients with SLAP type II were arthroscopicaly operated. There were 6 males and 1 female aged from 31 to 52 years. 4 patients had an associated rotator cuff partial rupture and 2, had a Bankart lesion with anterior instability. Arthroscopy was performed under general anesthesia with the patients in the beach chair position. We used the standard posterior and anterior portals and also a third superior-anterior. We used VAPR and shaver for preparation and slight decortication of superior glenoid. With a special curved needle we passed a suture PDS NoI from the superior anterior labrum then through a Mitek GII anchor which we place after predriling at the superior glenoid. The Ethibon suture of the anchor was passed through the posterior superior labrum. We used arthroscopic knots to tie down the sutures. Finally the superior labrum is stabilized with 2 sutures in V configuration through a singular Mitek GII anchor anterior and posterior the anchor of biceps. Postoperative care depended on coexisting lesions. Most of the patients had their shoulder immobilized for 3 weeks in a sling.

Results: The average follow up was 18 months (12–22). All patients had complete resolution of the preoperative pain. 5 patients had full range of movements and no functional restriction. The remaining 2 patients had a slight restriction of movements mainly in internal rotation. All patients had normal muscle strength and all had constant score above 80.

Conclusion: Stabilization of the superior labrum with the described technique is successful and effective for type II SLAP lesion treatment. We believe that arthroscopic examination of the shoulder should be done even before an open shoulder surgery for other pathologies. Arthroscopy is the only way to detect a coexisting SLAP lesion and repair it, otherwise it may negatively influence the success of the operation.