What is a Bankart (Bankart lesion repair) repair?

Bankart Repair: A Surgical Procedure for Anterior Shoulder Instability

A Bankart repair is a surgical procedure that addresses anterior shoulder instability by reattaching the torn labrum and capsule to the glenoid rim of the shoulder socket, restoring stability to the shoulder joint and preventing recurrent dislocations. 1

Anatomy and Pathology

The Bankart lesion is the critical anatomic injury in most patients with anterior glenohumeral instability, characterized by:

• Detachment of the anteroinferior labrum from the glenoid rim
• Often accompanied by capsular avulsion from the anterior glenoid
• May include various patterns of injury, including:
  • Classic Bankart lesion (labrum and capsule torn from glenoid)
  • Capsule stripped from scapular neck with labrum detached
  • Labral abrasion
  • Glenoid rim fracture 2

Diagnostic Imaging

MR arthrography is the preferred imaging modality for evaluating Bankart lesions:

• Highest sensitivity (86-100%) for detecting labral tears 3
• Superior to non-contrast MRI for diagnosing labroligamentous injuries 1
• Equivalent to CT in assessing glenoid and humeral head bone loss 1

Alternative imaging options include:

• Standard MRI without contrast (if optimized equipment available)
• CT arthrography (only if MRI is contraindicated)
• Plain radiographs (initial screening for fractures) 3

Surgical Procedure

The arthroscopic Bankart repair involves:

1. Identification of the detached anteroinferior labrum
2. Preparation of the glenoid rim (creating a bleeding surface)
3. Placement of suture anchors into the glenoid rim
4. Reattachment of the labrum and capsule to the glenoid 4

Important technical considerations:

• The capsule is reattached to the bony rim of the anteroinferior glenoid, lateral to the torn cartilaginous labrum 2
• Accessory portals may be needed for lesions extending posteriorly beyond the 6-o'clock position 5
• Proper anchor placement and suture management are critical for successful repair 4

Indications for Surgery

Surgery is indicated after:

• Failure of conservative measures after 3-6 months
• Significant functional limitations despite therapy
• Evidence of instability
• Young, active patients with high physical demands 3

Outcomes and Complications

The procedure has:

• Generally good outcomes with low complication rates
• Allows many patients to return to sports at pre-injury levels 6

However, important considerations include:

• Long-term failure rates may be higher than alternative procedures like Latarjet 7
• Risk factors for recurrence include:
  • ISIS score ≥3
  • Glenoid bone lesions
  • Hill-Sachs lesions >15% 7
• Potential complications include:
  • Recurrent instability (most common)
  • Neurovascular injuries
  • Infection
  • Shoulder stiffness
  • Long-term arthritis 6

Patient Selection

Proper patient selection is crucial for successful outcomes:

• Best results in patients with minimal glenoid bone loss 4
• Patients over 30 years may have higher recurrence rates (37% at 12-year follow-up) 7
• Alternative stabilization techniques should be considered for patients with significant bone defects 7

For optimal outcomes, thorough preoperative assessment of bone loss and careful patient selection are essential to ensure the appropriate surgical approach is selected for each individual case.