Inlay Dynamic Anterior Stabilization With the Long Head of the Biceps Tendon and Remplissage Procedure for Patients With Subcritical Glenoid Bone Loss and On-Track Hill-Sachs Lesion

Abstract

Augmented Bankart with dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHBT) aims to address anteroinferior glenohumeral instability but does not specifically target Hill-Sachs lesions. The remplissage technique, “filling” the Hill-Sachs lesion, is popular for off-track lesions. The proposed combined approach seeks to stabilize the humeral head without sacrificing the coracoid, making it suitable for high-risk patients prone to recurrent shoulder instability, such as patients with subcritical glenoid bone loss. The operative technique includes patient preparation, creation of arthroscopic portals, confirmation of glenoid bone loss and other injuries, LHBT preparation and tenodesis to the anterior glenoid, and completion of the remplissage procedure. Postoperative protocols involve wearing a sling, self-mobilization, and gradual return to sports. The method aims to improve stability and outcomes in patients with complex shoulder instability issues. The DAS and remplissage is a rational choice for high-demand patients with subcritical glenoid bone loss and on-track Hill-Sachs lesions because it may provide better stability than isolated Bankart repair or Bankart plus remplissage procedures.