1. Arthroscopic Transtendinous Double-Pulley Remplissage Technique in the Beach-Chair Position for Large Hill-Sachs Lesions 
Nata Parnes, M.D., MAJ Paul A. Carey, M.D., Christopher Schumacher, M.D., Mark D. Price, M.D., Ph.D. 
Arthroscopy Techniques 
Volume 4, Issue 4, Pages e305-e309 (August 2015)
DOI: /j.eats
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Hill-Sachs deformity (HS) of the left shoulder viewed from the anterosuperior portal with the patient in the beach-chair position. The lesion has been prepared with extensive rasping to create a good bed of bleeding bone for better ingrowth of the infraspinatus tendon once it is pulled into the lesion. (AS, articular surface.)
Arthroscopy Techniques 2015 4, e305-e309DOI: ( /j.eats )
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Guidewire insertion. The transtendinous needle is inserted percutaneously through the infraspinatus and posterior capsule to a point at the inferior margin of the Hill-Sachs lesion. This will be used to guide anchor placement.
Arthroscopy Techniques 2015 4, e305-e309DOI: ( /j.eats )
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
First anchor insertion. A transtendinous anchor is placed through a metal cannula that has been inserted over the guidewire. This is a single-loaded titanium anchor.
Arthroscopy Techniques 2015 4, e305-e309DOI: ( /j.eats )
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Second anchor insertion. This anchor is inserted in the same manner as the first but at the superior aspect of the Hill-Sachs lesion. One limb from each suture is tied together in a double-pulley fashion to fill the Hill-Sachs defect with the infraspinatus tendon.
Arthroscopy Techniques 2015 4, e305-e309DOI: ( /j.eats )
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
After both limbs have been tied together, the infraspinatus tendon in nicely positioned into the Hill-Sachs defect. Joint congruency and stability have been restored.
Arthroscopy Techniques 2015 4, e305-e309DOI: ( /j.eats )
Copyright © 2015 Arthroscopy Association of North America Terms and Conditions