Onlay Dynamic Anterior Stabilization of the Shoulder With the Biceps Augmented by Hill‐Sachs Remplissage for On‐ and Off‐Track Lesions

Arthroscopic dynamic anterior stabilization (DAS) using the long head of the biceps tendon is a soft-tissue technique indicated for the treatment of anterior glenohumeral instability with anterior glenoid bone loss of up to 20%, with or without associated SLAP tears. Onlay DAS adds the labroplasty effect to the sling and hammock effects provided by the inlay DAS and may increase anterior glenohumeral stability by restoring the concavity-compression effect of the missing labrum in patients with chronic anterior glenohumeral instability. In patients with bipolar bone loss who participate in contact or collision sports, augmenting onlay DAS with Hill-Sachs remplissage may further increase stability and reduce the risk of recurrence. This technical note presents key pearls and modifications to the onlay DAS procedure using the double double-pulley technique, including arthroscopic suture management strategies for the onlay biceps transfer to the anterior glenoid augmented by Hill-Sachs remplissage using all-suture anchors.