The optimal treatment for recurrent glenohumeral instability is a subject under debate. The recently described arthroscopic technique for dynamic anterior stabilization (DAS) fills the treatment indication gap between reconstructive bony procedures and soft tissue stabilization. However, indications for DAS are considered limited or not appropriate for patients with recurrent shoulder dislocations caused by severe bone defects. In this Technical Note, we present a modified all‐arthroscopic DAS technique with added infraspinatus and posterior capsule remplissage to correct the extra‐articular Hill‐Sachs defect in a patient with recurrent dislocations and off‐track bony lesions. The patient requested an alternative treatment option, other than the complication‐prone Latarjet procedure. Technique Video: video See video under supplementary data.

Background: The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage. Purpose: To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL. Study Design: Meta-analysis; Level of evidence, 3. Methods: PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms “remplissage” and “shoulder instability” according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up. Results: From 802 articles found during the initial search, 7 studies with a total of 837 patients—558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)—were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, –1.43°; 95% CI, –2.40° to –0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, –1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, –61.60; 95% CI, –148.03 to 24.82; P = .162) scores that were comparable with those of the BR group. Conclusion: Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients’ external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.

Arthroscopic shoulder surgery has undergone significant advancements over the past decades, transitioning from a primarily diagnostic tool to a comprehensive therapeutic approach. Technological innovations and refined surgical techniques have expanded the indications for arthroscopy, allowing minimally invasive management of shoulder instability and rotator cuff pathology. Methods: This narrative review explores the historical evolution, current trends, and future perspectives in arthroscopic shoulder surgery. Results: Key advancements in shoulder instability management include the evolution of the arthroscopic Bankart repair, the introduction of the remplissage technique for Hill–Sachs lesions, and the development of arthroscopic Latarjet procedures. Additionally, novel techniques such as Dynamic Anterior Stabilization (DAS) and bone block procedures have emerged as promising solutions for complex instability cases. In rotator cuff repair, innovations such as the suture-bridge double-row technique, superior capsular reconstruction (SCR), and biological augmentation strategies, including dermal allografts and bioinductive patches, have contributed to improving tendon healing and functional outcomes. The role of biologic augmentation, including biceps tendon autografts and subacromial bursa augmentation, is also gaining traction in enhancing repair durability. Conclusions: As arthroscopic techniques continue to evolve, the integration of biologic solutions and patient-specific surgical planning will likely define the future of shoulder surgery. This review provides a comprehensive assessment of current state-of-the-art techniques and discusses their clinical implications, with a focus on optimizing patient outcomes and minimizing surgical failure rates.

Background: There is no clear consensus on the treatment of partial articular‐sided supraspinatus tendon avulsions. Debridement alone might not be sufficient to prevent further tendon degradation or alleviate patient complaints. Direct repair using a suture anchor without treating the concomitant conditions of the long head of the biceps tendon might come with residual anterior shoulder pain or even further loss of function in cases of failed repair. The purpose of the present study is to describe an arthroscopic technique by which the long head of the biceps tendon can be included in the partial articular‐sided supraspinatus tendon avulsion repair.Technique Presentation with video: In this technical note we describe the arthroscopic repair and augmentation with tenotomized biceps of partial supraspinatus tendon tears to address three main concepts for successful rotator cuff repairs, namely rotator cuff biologic augmentation, tendon to bone healing and postoperative pain prevention.Conclusion: The biceps tendon is a mechanically robust, locally available autograft that can be used in borderline partial articular‐sided supraspinatus tendon avulsions in order to biologically augment healing at the tendon‐bone interface without any immunogenic reactions or morbidity following harvesting.