The Addition of Remplissage to Arthroscopic Labral Repair is Associated with Lower Rates of Recurrent Instability and Higher Rates of Return to Sport for Patients with On-Track Hill-Sachs Lesions: A Systematic Review and Meta-Analysis of Comparative Studies

INTRODUCTION Despite being initially described for off-track Hill-Sachs lesions (HSL), the addition of Remplissage to arthroscopic labral repair (ALR) for on-track HSL continues to generate significant interest. Therefore, the purpose of this study is to evaluate outcomes for ALR with and without Remplissage for on-track HSL. METHODS A preregistered PRISMA-compliant systematic review and meta-analysis was performed using PubMed, Embase, and CINAHL from database inception until October 23 rd , 2025. Inclusion criteria were comparative studies for ALR with Remplissage (ALR+R group) versus ALR alone without Remplissage (ALR group) for on-track HSL. Primary outcomes included recurrent instability events, return to sport, and revision surgery. A random effects meta-analysis with relative risk (RR) was conducted. RESULTS Eight articles were included out of 170 retrieved. Patients (n=928; mean age: 24.0 years; 79.1% male; follow-up: 33.5 months; distance-to-dislocation: 14.2 mm; Hill-Sachs interval: 9.6 mm; percent of glenoid bone loss: 3.8%) were stratified into ALR+R (n=298) and ALR (n=630) groups. ALR+R patients had a 72% lower risk of recurrent instability events compared to ALR patients (RR: 0.28; p<0.001; 3.4% versus 16.0%). Among contact athletes only, the recurrent instability rate was 2.0% (n=1) in the ALR+R group (n=50) and 16.7% (n=9) in the ALR group (n=54). There was a statistically significant 15% higher risk of return to sport in the ALR+R group as compared to patients in the ALR group (RR: 1.15; p=0.003; 76.3% versus 68.9%). There was no difference in revision rates for the ALR+R group despite a greater than fourfold higher revision rate in the ALR group (p=0.08; 1.6% versus 7.4%). Certainty of evidence for all analyses was "very low" due to the quality of evidence. CONCLUSION The addition of Remplissage to ALR for on-track HSL appears to have clinically and statistically significant benefits for reducing the risk of postoperative recurrent instability events as well as promoting higher rates of return to sport, despite very low certainty of evidence. Future randomized controlled trials are needed for corroboration.