How to Do a Remplissage

In this video, Dr. Grant H. Garcia breaks down the technical execution, proper ordering, and tool selections for performing a successful shoulder remplissage procedure.

Here is a summary of the core surgical points he outlines:

• Surgical Positioning and Arm Manipulation: While a remplissage can be performed in either a sitting-up position (beach chair) or on the side (lateral decubitus), Dr. Garcia re-emphasizes that lateral decubitus is his absolute workhorse method. He shares that the key to mastering this surgery relies on knowing exactly how to drop the traction and rotate the patient's arm to properly open up and identify the bone defect.
• The Crucial Order of Operations: When performing a combined procedure, order matters immensely. The surgeon must first place the hardware anchors into the Hill-Sachs bone defect and cinch them down before finishing the front-facing labral repair. Once the labral repair is fully secure, the surgeon goes back and completes the final tightening of the remplissage.
• Transitioning to Knotless FiberTacks: In line with modern surgical advancements, Dr. Garcia highlights a shift away from using older, knotted lock mechanisms toward utilizing the same ultra-small knotless FiberTack anchors he uses for cartilage repairs. These newer anchors require much less bone disruption, leave a smaller footprint, and do not require the surgeon to tie complex physical knots.
• An Efficient Future for Better Outcomes: He emphasizes that ongoing procedural developments will soon make this addition incredibly efficient for any operating surgeon. Ultimately, making the procedure faster and more accessible ensures that patients receive a drastically reduced risk of a repeat dislocation—an outcome desired by the patient, their family, and the medical team alike.