Shoulder joint is the joint with the greatest mobility among all the joints in the human body, and it is also the joint with relatively weak stability. Shoulder dislocation accounts for about 50% of the joint dislocations in the whole body, and it mostly occurs in the young and middle-aged people. Recurrent anterior shoulder dislocation refers to repeated dislocation of the shoulder joint caused by slight external force or certain movements in life after the initial trauma when the damaged joint capsule and glenoid labrum have not been repaired. Tearing of the joint capsule and glenoid labrum at the front of the shoulder joint caused by recurrent anterior dislocation of the shoulder is known as a Bankart injury; when the shoulder joint is dislocated anteriorly, the humeral head strikes the glenoid rim of the joint can lead to an inset fracture of the humeral head, which is known as a Hill-Sachs injury. When recurrent anterior shoulder dislocation Bankart combined with Hill-Sachs injury, treatment is often difficult. In our department, 13 cases of recurrent anterior shoulder dislocation Bankart combined with Hill-Sachs injury were treated with shoulder arthroscopic Bankart repair and Remplissage from March 20011 to March 2012, and the postoperative follow-up was more than 12 months, with satisfactory efficacy, which is reported as follows. 1, Data and Methods 1.1 General information There were 13 cases of patients in this group, 11 male and 2 female; 4 cases on the left side and 9 cases on the right side; the maximum age was 42 years old, the minimum age was 17 years old, and the average age was 27.4 years old; there were 2 cases of car accident injuries, and 11 cases of fall injuries; the shortest time of medical history was 7 months, and the maximum time of medical history was 18 years, and the average time of medical history was 4.3 years; all of the 13 cases were uni-directional instability, and there was no multi-directional instability. 1.2 Surgical methods The patients were put under general anesthesia, took the healthy side lying position, tilted backward about 30°, the affected shoulder was abducted 30°, flexed anteriorly 15°, and was given axial traction with 3kg weights. The posterior approach, anterior superior approach and anterior approach were established respectively. The posterior approach was taken as the observation approach, and the presence of Bankart injury, Hill-Sachs injury and scapular glenoid defect was observed. The arthroscopic lens is transferred from the posterior approach to the anterosuperior approach to visualize the location and size of the Bankart injury and the bone defect. A small incision is made just outside and above the posterior approach, drilled through the trocar, and a double suture anchor nail is implanted into the superior margin of the Hill-Sachs injury. The trocar was gently withdrawn to place it posteriorly between the infraspinatus and deltoid muscles, and the subdeltoid bursa was cleared until the deltoid and infraspinatus gaps were large enough for subsequent manipulation, and the suture anchor nail caudal threads were guided through the exits of the different joint capsules with a suture hook, but not knotted. The anterosuperior approach is the observation approach, and the anterior and posterior approaches are the working approaches. The avulsed glenoid labrum is peeled off, and the scapular glenoid is sanded down to the subchondral bone, and two to four double-wire suture anchors or winged anchors are drilled and implanted to repair the avulsed glenoid labrum and the articular capsule composite structure. The anchor sutures placed in the Hill-Sachs injury area are then knotted in the infraspinatus and deltoid spaces, and the posterior joint capsule and infraspinatus muscle are extruded to fill the Hill-Sachs bone defect. Each arthroscopic portal was closed sequentially (Figs. 1 to 8). Figure 1 Recurrent anterior dislocation of the shoulder joint Figure 2 MRI performance after repositioning Figure 3 Bankart injury Figure 4 Hill-Sachs injury Figure 5 Bankart repair Figure 6 Remplissage Figure 7-8 Postoperative X-ray 1.3 Postoperative treatment After the operation, the upper limb was braked by suspension immobilization band for about 4-6 weeks, and then the shoulder joint was gradually exercised, and the shoulder joint basically resumed normal joint activities 10-12 weeks after the operation. After 10 to 12 weeks of operation, the shoulder joint function exercise was gradually performed, and the normal joint activity was basically resumed in 10 to 12 weeks after operation. The 13 patients in this group were followed up for more than 12 months, and the preoperative and postoperative shoulder functions of the 13 patients were evaluated by using the ASES and Rowe scores of the shoulder joint. the ASES scores of the 13 patients in the preoperative and 1-year postoperative period were 69.8 and 93.7, which were statistically significant, and the Rowe scores of the 13 patients were 31.3 and 84.2, which were statistically significant. There was no recurrent dislocation in any of the 13 patients at postoperative follow-up, and further clinical follow-up is needed for more long-term results. The anatomical characteristics of the shoulder joint determine that it is an unstable joint. The head is large and the glenoid is small, and the depth of the glenoid is only 2.5 mm. Although the glenoid labrum can increase and deepen the glenoid, it still cannot provide enough stability, and the joint capsule, ligaments and muscles around the joint are still needed to maintain it. The stabilizing mechanism of the shoulder joint is maintained by both dynamic and static factors. Static factors include the bony structure and geometry of the glenohumeral joint (ensuring that the center of rotation of the shoulder overlaps with the center of the curved surface of the skin head), negative intra-articular pressure (-4 mm Hg), the structure of the joint capsule-glenoid labrum complex, the rostro-humeral ligament, and the glenohumeral ligament, etc. Dynamic factors refer to the musculature surrounding the shoulder joint (rotator cuff, deltoid, and the tendon of the long head of the biceps muscle, etc.). Muscle and soft tissue interactions around the shoulder joint are the main source of shoulder joint stability. Injury to any part of the stabilizing structures of the shoulder joint can lead to instability of the shoulder joint complex. Due to the unique anatomical and biomechanical characteristics of the shoulder joint, the shoulder joint is one of the most unstable and frequently dislocated joints in the body, accounting for about 50% of all joint dislocations. In the past, failure to immobilize the shoulder for 3-4 weeks after initial dislocation was considered to be the main reason for recurrence of dislocation, but McLaughlin and Cavallaro’s study showed that age is a very important factor, they studied lOl patients with acute dislocations, and 90% of dislocations were recurrent in patients younger than 20 years old, and 60% in patients aged 20-40 years old, while only 10% of dislocations occurred in patients older than 40 years old. Only 10% of patients over 40 years of age had recurrent dislocations. Rowe and Sakellarides found in 324 patients with dislocations that 94% of patients younger than 20 years of age had recurrent dislocations.McLaughlin and Cavallaro and McLaughlin and MacLellan concluded that the incidence of recurrent dislocations depends largely on the site and nature of the injury at the time of the first dislocation.Rowe’s study showed that the cause of the first dislocation was the location and nature of the injury. Rowe’s study showed that the greater the trauma that caused the first dislocation, the lower the incidence of recurrent dislocation. The most common pathologic changes associated with recurrent anterior shoulder dislocations are Bankart injuries, Hill-Sachs injuries, biceps tendon inflammation or injury, SLAP injuries, and rotator cuff injuries. When Bankart is combined with a larger Hill-Sachs injury, its treatment is often more difficult. When recurrent anterior shoulder dislocation Bankart combined with large Hill-Sachs injury, incisional Bankart surgery is the “gold standard” for the treatment of recurrent anterior shoulder dislocation because it has a lower postoperative recurrence rate and higher reliability than arthroscopic surgery. However, with the continuous improvement of arthroscopic technology and instruments, the success rate of arthroscopic Bankart repair has gradually increased. In 2008, Wolf firstly adopted the arthroscopic filling of the infraspinatus tendon and the posterior joint capsule in the Hill-Sachs injury area, i.e., arthroscopic Remplissage, which can effectively convert intra-articular injuries into extra-articular injuries, and prevent the anterior displacement of the defective humeral head from engaging the anterior glenoid rim of the shoulder. This technique has been rapidly popularized and applied, and its clinical efficacy is fully comparable to that of incision surgery, and has great value for promotion because of its low trauma and good functional recovery. In our group, 13 patients were treated with shoulder arthroscopic Bankart repair and Remplissage for recurrent anterior dislocation of the shoulder joint combined with Hill-Sachs injury, and good efficacy was achieved. However, the postoperative follow-up time was short, and it is still necessary to observe the functional limitation of the shoulder joint in the long term, the performance of the muscle strength, and the healing of tendon fixation on the Hill-Sachs injury area with the aid of MRI. The results are summarized in the following table.