The Tripod-Pulley Technique for Arthroscopic Remplissage in Engaging Hill-Sachs Lesions

Arthroscopic Bankart repair is now a well-established technique for the treatment of shoulder instability. However, failure rates are considerable when significant bony defects are not addressed. Hill-Sachs lesions, present in the vast majority of those with recurrent anterior instability, when of significant dimension and location, may account for some of these failures. The remplissage procedure involves capsulotenodesis of the posterior capsule and the infraspinatus tendon to fill the Hill-Sachs lesion. “Double-pulley” remplissage is a transtendinous technique that has been described elsewhere and that may simplify the procedure. We present a modification of this technique, the “tripod-pulley” technique, which we feel may potentiate healing of the Hills-Sachs lesions of the capsule and infraspinatus by increasing the surface contact area. At the same time, this technique minimizes the risk of potential damage to the infraspinatus as it uses 2.3-mm “all-suture” anchors.