Changes in Rate and Indications for Remplissage When Performing Arthroscopic Bankart Repair for Anterior Shoulder Instability

Background: Remplissage is used as an adjunct to arthroscopic Bankart repair (ABR) to reduce recurrent instability. Despite growing evidence supporting efficacy and broader application of the procedure, the absence of a specific procedural code limits knowledge of its utilization, and current surgical indications are not well defined. Hypothesis: It was hypothesized that remplissage utilization would increase over the study period and that indications would expand beyond traditionally defined off-track Hill-Sachs lesions. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing arthroscopic anterior shoulder stabilization from 2012 to 2024 were retrospectively reviewed across multiple institutions. Patients were grouped by ABR alone (ABR) or with remplissage (REMP). Temporal trends were evaluated by comparing early (2012-2020) and late (2021-2024) cohorts. Preoperative magnetic resonance imaging was used to assess bipolar bone loss using established measurement techniques, including glenoid track (GT), glenoid bone loss (GBL), and distance to dislocation (DTD). Results: The cohort included 244 patients who underwent remplissage and 1100 patients who underwent ABR. The proportion of REMP increased 4.5-fold over the study period (7.7% in 2012 vs 34.7% in 2024). Later year of surgery was significantly associated with increased remplissage utilization (odds ratio [OR] per year, 1.21 [95% CI, 1.16-1.27]; P < .001). There were no differences in age ( P = .53), sex ( P = .10), or contact athletes ( P = .35) between cohorts. The REMP cohort had more preoperative dislocations (3.1 ± 2 vs 1.5 ± 1.4; P < .001). Among patients with REMP, those in the late subgroup had fewer preoperative dislocations (2.7 ± 1.7 vs 3.9 ± 2.4; P = .01) and lower sports participation (58% vs 71%; P = .04). The late REMP subgroup also demonstrated greater GBL (7.3 ± 6.4% vs 5.6 ± 6.1%; P = .04) and shorter DTD (4.7 ± 4.6 vs 6.1 ± 4.8 mm; P = .03). GT classification did not differ between early and late REMP subgroups ( P = .12), with approximately 75% of patients classified as near-track or on-track. Conclusion: The utilization of remplissage as an adjunct to ABR has increased 4.5-fold over the past decade. The majority of patients who underwent remplissage in this series had near-track or on-track lesions, suggesting a lower utilization threshold rather than greater pathology severity. This study defines trends in utilization and indications, while future work should determine whether these evolving practices translate into improved outcomes.