From the Guidelines
Bankart lesions should be surgically repaired within 3-6 months of injury to prevent chronic instability and further damage, as delayed repair can lead to increased morbidity and decreased quality of life. The optimal timing for repair of Bankart lesions depends on the severity of the injury and individual patient factors, such as age and activity level. For acute injuries, conservative treatment with immobilization and physical therapy may be attempted for 3-6 weeks, but if symptoms persist, surgical repair is often recommended 1.
Evaluation and Treatment
A Bankart lesion is a tear of the labrum in the shoulder joint, often resulting from dislocation. Initial treatment typically involves rest, ice, and pain management with NSAIDs like ibuprofen. Physical therapy focusing on shoulder strengthening and stability exercises is crucial, regardless of whether surgery is planned. MR arthrography is the preferred study for evaluating subacute or chronic Bankart lesions due to its soft-tissue contrast and ability to delineate humeral head and glenoid cartilage 1.
Surgical Repair
For surgical repair, arthroscopic techniques are commonly used, involving reattaching the torn labrum to the glenoid rim using suture anchors. Post-surgery, the arm is immobilized in a sling for 4-6 weeks, followed by a graduated rehabilitation program lasting several months. Prompt treatment is important because repeated dislocations can lead to chronic instability, increased risk of arthritis, and more extensive tissue damage, potentially complicating future repair efforts 1.
Key Considerations
- The exact timing of surgical repair should be determined in consultation with an orthopedic specialist based on the individual's specific circumstances and goals.
- Delayed repair can lead to increased morbidity and decreased quality of life, making prompt treatment essential.
- Arthroscopic techniques are commonly used for surgical repair, and MR arthrography is the preferred study for evaluating subacute or chronic Bankart lesions.
From the Research
Optimal Timing for Repair of Bankart Lesions
The optimal timing for repair of Bankart lesions is a crucial factor in determining the outcome of the treatment.
- Early diagnosis and treatment are essential to prevent long-term shoulder instability, as stated in the study 2.
- The study 3 suggests that acute bony Bankart lesions can be successfully treated with an arthroscopic approach, and the outcomes are more favorable when treated early, with a lower rate of recurrent instability.
- The mean time from dislocation event to surgery was 12.8 months for the arthroscopic group and 13.6 months for the open Latarjet group in the study 4, indicating that early intervention is not always possible.
- However, the study 4 also found that patients with larger glenoid bone loss (>13.5%) had worse outcomes with arthroscopic repair, suggesting that the timing of the repair may depend on the size of the lesion.
- Another study 5 reported favorable outcomes with the arthroscopic "bony Bankart bridge" repair technique at a minimum 5-year follow-up, with a mean time from most recent injury to surgery of 6.3 months.
Factors Influencing the Optimal Timing
Several factors can influence the optimal timing for repair of Bankart lesions, including:
- Size of the lesion: Larger lesions may require earlier intervention to prevent further bone loss and instability 4.
- Patient characteristics: Young male athletes playing contact sports are at higher risk of sustaining bony Bankart lesions and may require earlier treatment to prevent recurrent instability 2.
- Treatment approach: Arthroscopic repair may be more suitable for acute lesions, while open Latarjet procedure may be more effective for chronic lesions with larger glenoid bone loss 4.