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Dr. Garcia demonstrates his new advanced technique for Remplissage. This is a great arthroscopic method for ..
Dr. Garcia specializes in complex knee, shoulder and elbow sports surgeries. He has prepared a number of surgical videos below to help patients better understand their procedures. He is frequently updating his surgical video database so check back soon for further updates.
This video demonstrates Dr. Grant Garcia's advanced arthroscopic technique for a Remplissage procedure, which is performed alongside an anterior labral (Bankart) repair to treat recurrent anterior shoulder instability.
The procedure is specifically indicated for patients who have an engaging Hill-Sachs lesion—a dent or bone defect on the back of the humeral head caused by repeated dislocations. When the arm is rotated, this dent can catch on the edge of the shoulder socket (glenoid), causing the joint to pop out again. The Remplissage technique addresses this by filling and "plugging" the defect.
The procedure is executed through the following key clinical steps:
- Defect Debridement & Preparation: Dr. Garcia accesses the back of the shoulder joint to visualize the Hill-Sachs defect on the humeral head. He debrides any soft tissue inside the crater and prepares the bone bed, creating a bleeding surface to optimize tissue-to-bone healing.
- Knotless Anchor Placement: High-strength anchors (typically knotless) are implanted directly into the bottom of the Hill-Sachs bone defect.
- Tendon Infiltration & Fixation: Using specialized suture passers, Dr. Garcia drives the anchor sutures through the overlying infraspinatus tendon and posterior shoulder capsule. The sutures are then tensioned and secured, pulling the active tendon and joint capsule directly down into the bone defect.
- Capsular Stabilization: By filling the bone crater with the patient's own tendon (tenodesis), the defect is structurally neutralized so it can no longer "catch" or engage the glenoid rim. This is paired with a standard anterior labral repair to rebuild the front bumper of the socket.
The final evaluation shows that the combined construct successfully fills the humeral defect and tightens the posterior capsule. This restriction safely blocks pathological anterior translation (forward slipping) of the humeral head, restoring stable shoulder mechanics.
