Kazuha Kizaki, MD | Soshi Uchida, MD, PhD

Failed Bankart repair with recurrent shoulder instability is relatively common, occurring in up to 20% of cases after primary surgery. Revision procedures are challenging due to compromised soft tissue quality, anterior glenoid bone loss, and the presence of Hill-Sachs lesion. In this context, bony augmentation procedures (such as Latarjet or bone block fixation) combined with remplissage are often selected, given that the anterior labrum is typically of insufficient quality for revision Bankart repair. Bone block fixation with remplissage does not require a steep learning curve, carries a lower risk of neurovascular injury, and has recently gained recognition as a reliable option for the management of failed Bankart repair.

This technical video illustrates a step-by-step technique for bone block fixation for anterior glenoid bone loss using an iliac crest autograft secured with double TightRope end-button constructs, supplemented by remplissage for Hill-saches lesion. Seven essential steps are outlined to optimize surgical outcomes. The procedure is performed arthroscopically through four portals: anterior inferior, anterior superior, posterior, and accessory posterior.

The sequence of the procedure is as follows:

1-Opening of the rotator interval

2-Remplissage preparation

3-Transglenoid drilling of the glenoid undersurface

4-Bone block preparation with double end-button configuration

5-Bone block fixation with double end-button configuration

6-Bankart repair covering the bone block

7-Completion of remplissage