Shoulder Instability in 2026

Shoulder Instability: Who Needs Surgery, and Why Remplissage Is Now Standard On an academic Friday, Dr. Brian Feeley and Dr. Drew Lansdown talk about shoulder instability. It comes up a lot in the fall, when football and high school sports start, and again in winter with snowboarding and skiing. They cover which first-time dislocators should think about surgery, how stabilization surgery has changed over the past decade, and when athletes can realistically return to play. In this episode: What "academic days" are. Why protected time for research, education and department work matters for surgeons whose operating schedules are unpredictable. Dislocation vs. separation. A glenohumeral dislocation (the ball comes out of the socket) compared with an AC joint "shoulder separation" (where the collarbone meets the shoulder blade). Who gets surgery. The main factors are how many times it has happened, age (under 21 carries a high risk of it happening again) and activity. Surfers and rock climbers may be offered surgery even after a first dislocation. Instability, not pain. Patients often feel fine between episodes, which makes the decision to operate less obvious. Physical therapy vs. surgery. PT strengthens the rotator cuff, which holds the ball in place. Surgery repairs the labrum and tightens the capsule. Remplissage explained. It means "to fill in" in French. The surgeon fills the Hill-Sachs lesion with the posterior capsule and infraspinatus tendon so the dent in the ball can't catch on the socket. Outcomes over time. In older series, about 1 in 5 young patients dislocated again after repair. UCSF's recurrence rate with modern technique is now about 3–5%. The biggest improvement is fewer subluxations, the feeling that the shoulder is about to slip out. Measuring the Hill-Sachs lesion. Width vs. craniocaudal (north-south) length vs. location, and why the threshold for adding remplissage keeps dropping. The billing problem. Remplissage has become close to standard of care, but there's no billing code for it. Return to sport. Plan on about 6 months, and base the decision on function (range of motion, strength, confidence), not just the calendar. Coming up: Latarjet and patellar instability. Hosts: Brian Feeley, MD, and Drew Lansdown, MD (UCSF) References discussed: MacDonald P, et al. Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg. 2021. Woodmass JM, et al. Arthroscopic Bankart repair with remplissage in anterior shoulder instability results in fewer redislocations than Bankart repair alone at medium-term follow-up of a randomized controlled trial. Am J Sports Med. 2024. Arthroscopic Bankart repair with and without remplissage in longer inferior craniocaudal Hill-Sachs extensions: secondary analysis of a randomized clinical trial. (PubMed 40744323) Cong T, …, Lin A. Defining critical humeral bone loss: inferior craniocaudal Hill-Sachs extension as predictor of recurrent instability after primary arthroscopic Bankart repair. Am J Sports Med. 2024. Subscribe to 6 to 8 Weeks: Perspectives in Sports Medicine on YouTube, Spotify, Apple Podcasts or wherever you listen. This podcast is for educational purposes and is not medical advice. Please subscribe to our podcast at Apple Podcasts Check out our website on Simplecast