What is the primary indication for Bankart (Bankart lesion repair) repair?

Primary Indication for Bankart Repair

Bankart repair is primarily indicated for recurrent anterior shoulder instability following traumatic anterior shoulder dislocation, particularly in young, active patients who have sustained a Bankart lesion (labral tear with or without glenoid bone loss). 1

Patient Selection Criteria

High-Priority Candidates for Surgical Repair

• Young athletes (especially under 30-35 years old) with first-time traumatic anterior dislocation who wish to return to contact sports or high-demand activities 2, 3
• Patients with recurrent anterior shoulder instability (multiple dislocations or subluxations) following initial traumatic dislocation 4, 5
• Documented Bankart lesion on MR arthrography (the gold standard imaging modality) showing labroligamentous injury 1, 6

Evidence Supporting Early Intervention

The strongest recent evidence demonstrates that primary arthroscopic Bankart repair after first-time dislocation reduces recurrent instability risk by 76-82% compared to conservative management in young patients. 3 This randomized, double-blind trial showed superior functional outcomes, higher patient satisfaction, and lower healthcare costs with early surgical intervention. 3

A systematic review further confirms that anatomic Bankart repair significantly reduces recurrent instability (RR 0.18) compared to immobilization or arthroscopic lavage alone, with better Western Ontario Shoulder Instability scores. 2

Risk Stratification for Surgical Decision-Making

Factors Favoring Bankart Repair

• ISIS score ≥3 (Instability Severity Index Score) 5
• Age under 30-35 years with high athletic demands 4, 3
• Contact sport athletes requiring return to sport 7, 3
• Presence of soft-tissue Bankart lesion without significant bone loss 4, 5

Critical Caveat: Bone Loss Assessment

Patients with significant glenoid bone loss or Hill-Sachs lesions >15% may have failure rates up to 37% with isolated arthroscopic Bankart repair and should be considered for alternative procedures like Latarjet. 5 The combination of ISIS score ≥3, glenoid bone lesion, and Hill-Sachs lesion >15% are independent risk factors for failure. 5

Conversely, patients with ISIS <3, no glenoid lesion, and Hill-Sachs ≤15% have 0% recurrence rate with arthroscopic Bankart repair, making them ideal candidates. 5

Diagnostic Workup Required

Imaging Algorithm

1. Initial plain radiographs (minimum 3 views: AP internal/external rotation, axillary or scapular Y-view) to assess for fractures and gross instability 1, 6
2. MR arthrography as definitive imaging for confirming Bankart lesion, assessing labroligamentous structures, and quantifying bone loss 1, 6
3. CT arthrography as alternative only if MRI contraindicated 1, 6

Physical Examination Findings

• Clinical shoulder instability with positive apprehension test 1
• History of traumatic anterior dislocation requiring reduction 4, 3
• Recurrent subluxation episodes or feeling of shoulder "giving way" 5

Treatment Timing Considerations

Early surgical intervention (primary repair after first dislocation) should be strongly considered in young competitive athletes to prevent recurrent instability and enable return to contact sports. 7, 3 One study of young athletes showed all patients returned to sport without restriction after early arthroscopic Bankart repair, with only one transient instability episode. 7

However, patients over 30 years old have higher failure rates (37% at 12-year follow-up) and require more careful patient selection based on bone loss and ISIS scoring. 5