Original Article| Volume 38, ISSUE 9, P2609-2617, September 2022

The Addition of Remplissage to Free Bone Block Restores Translation and Stiffness Compared to Bone Block Alone or Latarjet in a Bipolar Bone Loss Model


      The purpose of this study was to compare glenohumeral stability following a Latarjet, a free bone block (FBB), and a FBB with remplissage for bipolar bone loss.


      Nine matched pairs of fresh frozen cadavers were tested in a custom biomechanical apparatus with rotation and progressive translational loading. The free bone block group consisted of a distal tibial allograft with an all-suture tape construct. The Latarjet group was performed with the native coracoid and two partially threaded cannulated screws. A bipolar bone loss model was created with 20% glenoid bone loss and an off-track Hill-Sachs lesion. Testing conditions included the 1) native state, 2) bipolar bone loss model, 3) Latarjet, 4) FBB with distal tibial allograft secured with cerclage sutures, and 5) FBB with remplissage. Each condition was tested for translation, humeral head apex shift, stiffness, and dislocation force.


      There were no differences in translation, stiffness, or dislocation forced between the FBB alone and Latarjet groups. The FBB with remplissage group demonstrated the lowest anterior-inferior translation at 90° of ER, which was statistically significant compared to Latarjet 20N (P = .013) and compared to the FBB alone at 40N (P = .024) and 50N (P = .011). The FBB with remplissage group was significantly stiffer compared to FBB alone at 90° ER with approximately 60% change in stiffness (P = .028). The force required to dislocate the humeral head after treatment was highest in the FBB with remplissage group, which was statistically significant compared to the FBB alone (P = .003) and Latarjet groups (P = .018).


      The addition of remplissage to a FBB restores translation and stiffness closer to the intact state compared to a FBB alone or Latarjet in a bipolar bone loss model with an off-track Hill-Sachs lesion. In this model, dislocation force significantly increased with the addition of remplissage to the FBB. Clinical Relevance: This biomechanical study provides evidence that Latarjet and FBB are both acceptable forms of treatment for bipolar bone loss, but stability can be enhanced with the addition of remplissage following glenoid reconstruction.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Burkhart S.
        • De Beer J.
        Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion.
        Arthroscopy. 2000; 16: 677-694
        • Yamamoto N.
        • Itoi E.
        • Abe H.
        • et al.
        Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track.
        J Shoulder Elbow Surg. 2007; 16: 649-656
        • Mizuno N.
        • Denard P.J.
        • Raiss P.
        • Melis B.
        • Walch G.
        Long-term results of the Latarjet procedure for anterior instability of the shoulder.
        J Shoulder Elbow Surg. 2014; 23: 1691-1699
        • Rollick N.
        • Ono Y.
        • Kurji H.
        • et al.
        Long-term outcomes of the Bankart and Latarjet repairs: A systematic review.
        Open Access J Sports Med. 2017; 8: 97-105
        • Hurley E.
        • Schwartz L.
        • Mojica E.
        • et al.
        Short-term complications of the Latarjet procedure: A systematic review.
        J Shoulder Elbow Surg. 2021; 30: 1693-1699
        • Domos P.
        • Lunini E.
        • Walch G.
        Contraindications and complications of the Latarjet procedure.
        Shoulder Elbow. 2017; 10: 15-24
        • Taverna E.
        • Garavaglia G.
        • Perfetti C.
        • Ufenast H.
        • Sconfienza L.
        • Guarrella V.
        An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 3780-3787
        • Malahias M.-A.
        • Chytas D.
        • Raoulis V.
        • Chronopoulos E.
        • Brilakis E.
        • Antonogiannakis E.
        Iliac crest bone grafting for the management of anterior shoulder instability in patients with glenoid bone loss: A systematic review of contemporary literature.
        Sports Med Open. 2020; 6: 1-11
        • Zhang M.
        • Liu J.
        • Jia Y.
        • Zhang G.
        • Zhou J.
        • Ding W.
        • Jiang J.
        • Yun X.
        Risk factors for recurrence after Bankart repair: a systematic review and meta-analysis.
        J Orthop Surg Res. 2022; 17: 113
        • Tokish J.
        • Shaha J.
        • Cook J.
        • Rowles D.
        • Shaha S.
        • Bottoni C.
        Predictive value and clinical validation of the “on-track” vs. “off-track” concept in bipolar bone loss in anterior glenohumeral instability.
        J Shoulder Elbow Surg. 2016; 25: e169
        • Hartzler R.
        • Bui C.
        • Jeong W.
        • Akeda M.
        • Peterson A.
        • McGarry M.
        • Denard P.
        • Burkhart S.
        • Lee T.
        Remplissage of an off-track Hill-Sachs lesion is necessary to restore biomechanical glenohumeral joint stability in a bipolar bone loss model.
        Arthroscopy. 2016; 32: 2466-2476
        • Kleiner M.
        • Payne W.
        • McGarry M.
        • Tibone J.
        • Lee T.
        Biomechanical comparison of the Latarjet procedure with and without capsular repair.
        Clin Orthop Surg. 2016; 8: 84-91
        • Lee Y.
        • Lee T.
        Specimen-specific method for quantifying glenohumeral joint kinematics.
        Ann Biomech Eng. 2010; 38: 3226-3236
        • Elkinson I.
        • Giles J.
        • Faber K.
        • et al.
        The effect of the remplissage procedure on shoulder stability and range of motion: An in vitro biomechanical assessment.
        J Bone Joint Surg. 2000; 82: 35-46
        • Rabinowitz J.
        • Friedman R.
        • Eichinger J.K.
        Management of glenoid bone loss with anterior shoulder instability: Indications and outcomes.
        Curr Rev Musculoskelet Med. 2017; 10: 452-462
        • Gilat R.
        • Haunschild E.
        • Lavoie-Gagne O.Z.
        • et al.
        Outcomes of the Latarjet procedure versus free bone block procedures for anterior shoulder instability: A systematic review and meta-analysis.
        Am J Sports Med. 2021; 49: 805-816
        • Buza J.
        • Iyengar J.
        • Anakwenze O.
        • Ahmad C.
        • Levine W.
        Arthroscopic Hill-Sachs remplissage: A systematic review.
        J Bone Joint Surg Am. 2014; 96: 549-555
        • Yang J.
        • Mazzocca A.
        • Cote M.
        • Edgar C.
        • Arciero R.
        Recurrent anterior shoulder instability with combined bone loss: Treatment and results with the modified Latarjet procedure.
        Am J Sports Med. 2016; 44: 922-932
        • Mook W.
        • Petri M.
        • Greenspoon J.
        • Horan M.
        • Dornan G.
        • Millett P.
        Clinical and anatomic predictors of outcomes after the Latarjet procedure for the treatment of anterior glenohumeral instability with combined glenoid and humeral bone defects.
        Am J Sports Med. 2016; 44: 1407-1416
        • Ranne J.
        • Sarimo J.
        • Heinonen O.
        • Orava S.
        A combination of Latarjet and remplissage for treatment of severe glenohumeral instability and bone loss. A case report.
        J Orthop. 2013; 10: 46-48
        • Katthagen J.
        • Anavian J.
        • Tahal D.
        • Millett P.
        Arthroscopic remplissage and open Latarjet procedure for the treatment of anterior glenohumeral instability with severe bipolar bone loss.
        Arthrosc Tech. 2016; 5: e1135-e1141
        • Ekhtiari S.
        • Horner N.
        • Bedi A.
        • Ayeni O.R.
        • Khan M.
        The learning curve for the Latarjet procedure: A systematic review.
        Orthop J Sports Med. 2018; 6: 1-7
        • Wong I.
        • Urquhart N.
        Arthroscopic anatomic glenoid reconstruction without subscapularis split.
        Arthrosc Tech. 2015; 4: 449-456
        • Valsamis E.M.
        • Kany J.
        • Bonnevialle N.
        • et al.
        The arthroscopic Latarjet: A multisurgeon learning curve analysis.
        J Shoulder Elbow Surg. 2020; 29: 681-688
        • Willemot L.B.
        • Elhassan B.T.
        • Sperling J.W.
        • Cofield R.H.
        • Sánchez-Sotelo J.
        Arthroplasty for glenohumeral arthritis in shoulders with a previous Bristow or Latarjet procedure.
        J Shoulder Elbow Surg. 2018; 27: 1607-1613
        • Zhu Y.
        • Jiang C.
        • Lu Y.
        • Li F.L.
        • Wu G.
        Coracoid bone graft resorption after Latarjet procedure is underestimated: A new classification system and a clinical review with computed tomography evaluation.
        J Shoulder Elbow Surg. 2015; 24: 1782-1788
        • Gupta A.
        • Delaney R.
        • Petkin K.
        • Lafosse L.
        Complications of the Latarjet procedure.
        Curr Rev Musculoskelet Med. 2015; 8: 59-66
        • Godenèche A.
        • Merlini L.
        • Roulet S.
        • Le Chatalier M.
        • Delgrande D.
        • Saffarini M.
        • Mateis M.
        Screw removal can resolve unexplained anterior pain without recurrence of shoulder instability after open Latarjet procedures.
        Am J Sports Med. 2020; 48: 1450-1455
        • Griesser M.
        • Harris J.
        • McCoy B.
        • Hussain W.
        • Jones M.
        • Bishop J.
        • Miniaci A.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: A systematic review.
        J Should Elbow Surg. 2013; 22: 286-292
      1. Hachem A, Del Carmen-Rodriguez M, Rondanelli R, et al. Arthroscopic bone block metal-free fixation for previous shoulder instability: Short-term functional and radiological outcomes. J Orthop Surg Traumatol In press. doi:10.1016/j.recot.2021.05.007.

        • Provencher M.
        • Frank R.
        • Golijanin P.
        • et al.
        Distal tibia allograft glenoid reconstruction in recurrent anterior shoulder instability: Clinical and radiographic outcomes.
        Arthroscopy. 2017; 33: 891-897