Shoulder instability: Bankart repair with vs without remplissage — what patients should know

Posted on: February 11th, 2026 by Our Team

Recurrent shoulder instability is not a minor issue. Once the shoulder has dislocated, the joint becomes more vulnerable to repeat episodes because the stabilizing tissues are stretched or torn. Over time, repeated dislocations can lead to ongoing pain, weakness, limited performance, and progressive cartilage damage that increases the likelihood of early arthritis. When instability persists despite rehabilitation, surgical stabilization is often the most reliable way to restore function and protect the joint long term. Modern surgical techniques focus on repairing damaged anatomy while minimizing loss of motion and recovery time.

What is a Bankart repair?

A Bankart repair is the foundation procedure for most cases of anterior shoulder instability. During a dislocation, the labrum — the ring of cartilage that deepens the socket — commonly tears away from the front of the glenoid. This injury reduces the shoulder’s natural restraint and allows the ball of the joint to slip forward again.

In a Bankart repair, the torn labrum and capsule are reattached to the bone using small anchors and sutures. Restoring this anatomy tightens the front of the joint, recreates stability, and allows the shoulder to function normally during daily activities and sports. For many patients, especially those without significant bone loss, this repair alone is sufficient to prevent recurrence.

What is remplissage?

Remplissage is an additional arthroscopic procedure that may be performed alongside a Bankart repair when extra stability is needed. Some patients develop a compression fracture or dent in the back of the humeral head during dislocation, known as a Hill-Sachs lesion. This defect can catch on the edge of the socket during motion, increasing the risk that the shoulder will dislocate again even after a standard repair.

Remplissage addresses this problem by filling the defect with the infraspinatus tendon and capsule. This effectively converts the bony defect into a non-engaging area and reduces the chance that the humeral head will slip out of place. The goal is straightforward: lower the recurrence risk without adding major surgical complexity.

When is remplissage needed?

Not every patient requires remplissage. The decision depends on measurable risk factors. Patients with larger Hill-Sachs lesions, glenoid bone loss, multiple prior dislocations, or participation in contact or collision sports have a higher chance of failure with a Bankart repair alone. Younger athletes and individuals returning to demanding overhead or contact activities also face higher recurrence rates.

In these situations, adding remplissage provides an extra margin of stability. Clinical studies consistently show lower redislocation rates when remplissage is combined with a Bankart repair in high-risk shoulders. For lower-risk patients, however, the additional step may not be necessary.

Balancing stability and motion

The main trade-off to consider is stability versus motion. Because remplissage tethers tissue to the back of the humeral head, there can be a small reduction in external rotation. For most patients, this difference is minimal and does not affect everyday function. For certain athletes, such as pitchers or throwers who rely on maximal rotation, even small changes can matter.

Careful patient selection and surgical technique are therefore essential. The objective is not simply to tighten the shoulder as much as possible, but to create a stable joint that still moves naturally and performs at the level the patient requires.

Recovery and expectations

Both procedures are typically performed arthroscopically through small incisions. After surgery, the arm is protected in a sling for several weeks while healing begins, followed by structured physical therapy to restore motion, strength, and control. Most patients return to daily activities within a few months, with sports clearance often occurring between four and six months depending on demands and healing.

Expert shoulder stabilization

Successful outcomes depend on matching the procedure to the patient’s anatomy, sport, and long-term goals. Dr. Ronak M. Patel specializes in advanced arthroscopic shoulder stabilization and uses evidence-based techniques to determine when a Bankart repair alone is appropriate and when adding remplissage offers a safer, more durable result. The focus is direct and practical: restore stability, preserve motion, and reduce the chance of future injury so patients can return to activity with confidence.