Treatment of Bankart Tears
For Bankart lesions, arthroscopic repair is the recommended surgical approach for most patients with symptomatic anterior shoulder instability, while the specific treatment strategy depends critically on the presence and extent of glenoid bone loss.
Initial Management Decision
The treatment pathway for Bankart tears fundamentally depends on whether the lesion is purely soft tissue (labral-ligamentous) or involves significant bone loss (bony Bankart):
Soft Tissue Bankart Lesions
Arthroscopic Bankart repair is the primary surgical treatment for symptomatic soft tissue Bankart lesions, as it effectively restores glenohumeral stability while preserving shoulder motion 1. The classic Bankart repair technique has demonstrated excellent long-term outcomes with only 3.5% recurrence rates and 74% excellent results, with 98% of patients rating their outcomes as excellent or good 2.
- Arthroscopic repair precisely restores posterior and inferior glenohumeral joint laxity to match the intact joint state 1
- Patients can expect early return of motion and function, with 69% achieving full range of motion 2
- Most patients (97-98%) return to competitive athletic activities without limitation 2
Bony Bankart Lesions
The treatment algorithm for bony Bankart lesions is determined by fracture characteristics 3, 4:
For acute fractures involving <15-20% of the inferior glenoid diameter:
- Non-operative treatment can be successful if the fracture is anatomically reduced after shoulder reduction 3
- However, in patients with high-risk profiles for recurrent instability (young male athletes in contact sports), initial Bankart repair is recommended 3, 4
For acute fractures involving >15-20% of the inferior glenoid diameter:
- Bony fixation is mandatory to prevent recurrent instability 3
- Arthroscopic repair remains the most common treatment method with favorable outcomes and low recurrence rates 4
For chronic bony Bankart lesions with significant bone loss:
- Management is case-by-case based on fragment resorption and anterior glenoid erosion 3
- Conservative therapy has high recurrence rates 3
- When significant anterior glenoid bone loss exists, reconstruction is indicated using either anatomical approaches (iliac crest bone graft, osteoarticular allograft) or non-anatomical procedures (Latarjet, Bristow) 3
Critical Pitfall to Avoid
Never perform open posterior bone block procedures for posterior Bankart lesions, as this technique overcorrects posterior translation while failing to restore inferior stability, creating abnormal joint mechanics 1. Arthroscopic posterior Bankart repair is superior because it more precisely restores the intact joint's laxity patterns 1.
Associated Pathology
When Bankart lesions are identified, systematically evaluate for concurrent injuries that require simultaneous repair 5: