Bankart Procedure: Definition, Candidates, and Recovery

What is the Bankart Procedure?

The Bankart procedure is a surgical intervention designed to repair a specific type of shoulder injury known as a Bankart lesion, which involves the detachment of the anterior-inferior labrum from the glenoid bone, typically occurring after an anterior shoulder dislocation.

Understanding Shoulder Anatomy and Stability

The shoulder joint, or glenohumeral joint, is the most mobile joint in the human body. This remarkable range of motion comes at the cost of inherent instability. The joint is a "ball-and-socket" type, where the head of the humerus (upper arm bone) articulates with the shallow glenoid fossa of the scapula (shoulder blade).

Key structures contributing to shoulder stability include:

• Glenoid Labrum: A fibrocartilaginous rim that deepens the glenoid socket, effectively increasing the contact area and stability of the joint.
• Joint Capsule: A fibrous sac enclosing the joint.
• Glenohumeral Ligaments: Thickened bands within the joint capsule that provide primary static stability, particularly against anterior and inferior displacement.
• Rotator Cuff Muscles: A group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and their tendons that dynamically stabilize the joint during movement.

What is a Bankart Lesion?

A Bankart lesion is a specific injury to the glenoid labrum. It occurs when the anterior (front) and inferior (bottom) part of the labrum, along with the attached inferior glenohumeral ligament, tears away from the front edge of the glenoid bone. This injury is most commonly caused by a traumatic anterior shoulder dislocation, where the humeral head is forced out of the socket in a forward direction. The forceful displacement can avulse (tear off) the labrum from its bony attachment.

The Purpose of the Bankart Procedure

The primary purpose of the Bankart procedure is to restore the stability of the shoulder joint and prevent recurrent anterior dislocations. By reattaching the torn labrum and tightening the stretched ligaments, the surgery aims to reconstruct the anatomical structures that stabilize the shoulder, allowing individuals to return to their activities without fear of repeated dislocations.

Who is a Candidate for the Bankart Procedure?

Candidates for the Bankart procedure typically present with:

• Recurrent Anterior Shoulder Dislocations: Individuals who have experienced multiple episodes of the shoulder dislocating anteriorly.
• Confirmed Bankart Lesion: Diagnosis is usually confirmed via Magnetic Resonance Imaging (MRI), often with contrast (arthrogram), which can clearly show the labral tear.
• Failure of Conservative Management: Patients who have not achieved adequate stability or relief from symptoms with non-surgical treatments like physical therapy.
• Active Individuals: Especially athletes or those with physically demanding occupations where shoulder stability is critical.

The Surgical Procedure

The Bankart procedure can be performed using two main approaches:

• Arthroscopic (Minimally Invasive) Bankart Repair: This is the most common approach. Small incisions (portals) are made around the shoulder, and a tiny camera (arthroscope) is inserted to visualize the joint. Specialized instruments are then used to:

  • Debride (clean up) any frayed tissue.
  • Mobilize the torn labrum.
  • Reattach the labrum and capsule to the anterior glenoid rim using small, absorbable or non-absorbable anchors with sutures. The sutures are passed through the labrum and capsule, then tied down to secure the tissue firmly against the bone.
  • The capsule may also be tightened (capsular plication) to further enhance stability.

• Open Bankart Repair: This involves a larger incision over the front of the shoulder. It is less common now but may be indicated in cases of significant bone loss from the glenoid or humerus (e.g., a large bony Bankart or Hill-Sachs lesion), or complex revision surgeries. While it offers direct visualization, it typically involves more soft tissue disruption and a longer recovery.

Recovery and Rehabilitation

Recovery after a Bankart procedure is a phased process that is crucial for optimal outcomes.

• Immobilization (0-4 weeks): The arm is typically kept in a sling, often with an abduction pillow, to protect the repair and allow initial healing. Passive range of motion exercises may begin under the guidance of a physical therapist.
• Early Motion (4-8 weeks): Gradual progression to active-assisted and then active range of motion exercises. The focus is on restoring joint mobility without stressing the repair.
• Strengthening (8-16 weeks): Introduction of light isometric and then progressive resistance exercises to strengthen the rotator cuff and scapular stabilizing muscles.
• Advanced Strengthening and Return to Activity (4-6 months+): Sport-specific drills, plyometrics, and functional training are incorporated. Return to high-impact or overhead activities is typically delayed until 6 months or more, depending on the individual's progress and the demands of their sport/occupation.

Physical therapy is paramount throughout the recovery period to ensure proper healing, restore range of motion, strength, and proprioception, and ultimately facilitate a safe return to desired activities.

Potential Risks and Complications

While generally safe and effective, like any surgical procedure, the Bankart repair carries potential risks:

• Infection: Though rare, a risk with any surgery.
• Bleeding: Post-operative hematoma.
• Nerve Damage: Injury to nerves around the shoulder, potentially leading to weakness or numbness.
• Stiffness (Arthrofibrosis): Formation of scar tissue that can limit range of motion. This is why early, controlled motion is important.
• Recurrent Instability/Re-dislocation: Although the procedure aims to prevent this, there's a small chance of re-dislocation, especially with subsequent trauma or non-adherence to rehabilitation.
• Persistent Pain: Some individuals may experience ongoing discomfort.
• Hardware Issues: Irritation or breakage of sutures or anchors (rare).

Prognosis and Long-Term Outlook

The Bankart procedure has a high success rate, with studies reporting prevention of recurrent dislocations in 85-95% of cases. Most patients achieve good to excellent functional outcomes, including a return to sports and daily activities. Long-term outcomes are generally positive, especially with diligent adherence to the prescribed rehabilitation protocol. However, individuals should be aware that while the risk of re-dislocation is significantly reduced, it is not entirely eliminated.

Bankart Procedure vs. Other Shoulder Stabilization Surgeries

It's important to differentiate the Bankart procedure from other shoulder stabilization surgeries:

• Latarjet Procedure: Used primarily when there is significant bone loss from the glenoid rim, which commonly occurs with recurrent dislocations. This procedure involves transferring a piece of bone (coracoid process) with its attached muscles to the anterior glenoid, providing a bony block to prevent dislocation.
• Capsular Shift: A procedure where the shoulder capsule is tightened and repositioned to improve stability, often used for multidirectional instability or generalized ligamentous laxity.

The Bankart procedure specifically addresses the soft tissue injury of the anterior-inferior labrum, making it the gold standard for traumatic anterior instability without significant bone defects.