The Latest Evidence on Bankart Repair Plus Remplissage for Shoulder Instability
For young, active patients, a shoulder that keeps dislocating is more than a nuisance — it tends to get worse with every episode. Thomas Obermeyer, MD, a fellowship-trained orthopedic surgeon specializing in shoulder surgery and sports medicine, treats anterior shoulder instability with a combined arthroscopic Bankart repair and remplissage, a state-of-the-art approach that the most current research continues to validate. A 2025 systematic review in the American Journal of Sports Medicine — a leading peer-reviewed journal in sports orthopedics — examined the longest follow-up available on this exact technique and found it to be both durable and motion-preserving(1), reinforcing why it has become a preferred solution for athletes with recurrent shoulder instability.
Understanding Anterior Shoulder Instability
The shoulder is the body’s most mobile joint, which also makes it the most prone to dislocation. Anterior, or forward, dislocations account for the large majority of cases, and they frequently tear the labrum and ligaments off the front rim of the socket — a Bankart lesion. The same injury often stamps a compression dent into the back of the humeral head, called a Hill-Sachs lesion. Once both exist, the shoulder can “engage,” catching and slipping out again, particularly in contact and collision athletes. Glenohumeral dislocations are common, with tens of thousands occurring in the United States each year, and recurrence rates after a first dislocation in young athletes can be very high.
Why Add Remplissage to a Bankart Repair?
A traditional arthroscopic Bankart repair reattaches the torn labrum to the socket, but on its own it does not address the Hill-Sachs defect — one reason reported failure rates in athletes vary so widely. Remplissage, French for “to fill,” solves that second problem. Using suture anchors, the surgeon fills the Hill-Sachs dent with the posterior capsule and infraspinatus tendon, converting the lesion from inside the joint to outside it so it can no longer engage the glenoid rim. Combining both repairs in a single, minimally invasive arthroscopic procedure addresses the complete instability pattern at once.
What the Latest Research Shows
The American Journal of Sports Medicine review pooled the studies with the longest follow-up available — an average of about nine years — and answered the two questions that matter most to patients: durability and motion. Recurrent instability occurred in only about 10% of shoulders, repeat dislocations in 8%, and just 4% required another operation, while 76% of patients returned to sport. Equally important, the analysis found no meaningful loss of forward elevation or external rotation, putting to rest a longstanding concern that remplissage might stiffen the shoulder. Those findings build on a landmark randomized controlled trial, published in the Journal of Shoulder and Elbow Surgery and followed up in the same journal as the American Journal of Sports Medicine review, showing that adding remplissage cut the two-year redislocation rate from 18% to 4% — an advantage that held at medium-term follow-up.
State-of-the-Art Technique: Knotless Fixation and 4K Arthroscopy
How the repair is performed matters as much as what is performed. Dr. Obermeyer routinely uses knotless suture anchors, a modern alternative to older repairs that relied on bulky knots tied inside the joint. Knotless fixation creates a lower-profile, smoothly tensioned construct with no knot stack to irritate cartilage or loosen over time. He performs these procedures through a state-of-the-art 4K arthroscopy tower, whose ultra-high-resolution imaging allows for more precise anchor placement and a more accurate, reproducible repair. Together, these tools represent the current standard of care in arthroscopic shoulder stabilization.
Return to Sport and Outcomes
For athletes, the bottom line is getting back to competition. Athlete-focused research in the American Journal of Sports Medicine reports roughly 86% return to sport after Bankart repair with remplissage, alongside low recurrence rates — and contact and collision athletes, historically the hardest group to keep stable, do especially well. Throwing and overhead athletes can be more variable, and Dr. Obermeyer counsels each patient individually on a realistic timeline. His goal in every case is the result this body of research describes: a stable, mobile shoulder and a confident return to the sport the athlete loves.
About Dr. Thomas Obermeyer
Thomas Obermeyer, MD, is a fellowship-trained orthopedic surgeon specializing in shoulder surgery and sports medicine, serving patients in Schaumburg and the northwest suburbs of Chicago. His areas of expertise include arthroscopic shoulder stabilization for instability, rotator cuff repair, total shoulder replacement, and knee procedures including ligament reconstruction and robotic-assisted knee replacement. He is known for a minimally invasive approach that helps patients return to activity with less downtime, and he teaches fellow orthopedic surgeons through national educational courses and surgical training programs. To schedule a consultation with Dr. Obermeyer, please contact his office or visit his website.
References:
- Tansey PJ Jr, Clark DS, Ruelos VCB, Lindeman RW, Somerson JS. Arthroscopic Bankart Repair With Remplissage Results in Low Recurrent Instability Rates Without Reducing Shoulder Range of Motion at Midterm Follow-up: A Systematic Review of Studies With Minimum 5-Year Outcomes. Am J Sports Med. 2025 Dec;53(14):3521-3527. doi: 10.1177/03635465251324930. Epub 2025 Sep 24. PMID: 40990567; PMCID: PMC12657661.
