Arthroscopic Anterior Labrum and Bankart Repair
What is a Bankart repair?
The term “Bankart repair” refers to a tear of the front, or anterior, portion of the labrum bumper in the shoulder socket. This procedure is named after the British orthopedic surgeon who described and popularized the procedure in the 1920s(1). The Bankart repair is the recommended procedure in patients who have dislocated the shoulder anteriorly (out the front) either one time or multiple times. Sometimes the procedure is recommended for symptoms of pain or apprehension (feeling of unsteadiness with overhead activity) in athletes.
When is a Bankart repair recommended?
As noted, repair is sometimes recommended in young patients who dislocate the shoulder for the first time. Prior to the advent of modern advanced (minimally invasive) surgical technique, surgery was almost never offered for first time dislocation, and instead the procedure was reserved until disabling pain and recurrent dislocations were observed. More recently, technology and technique for noninvasive outpatient repair is better which does not significantly change recovery time compared with sling immobilization. These observations, coupled with emerging evidence that early surgery results in better outcomes, have resulted in changes to recommendations in some younger at-risk patients. Specifically, it has been shown that athletes younger than the age of 25 who are at-risk of re-dislocating the shoulder, primary repair performs better than nonsurgical treatment at 2 year follow up(2).
The most common indication for Bankart repair is in the setting of recurrent dislocation. When the shoulder has dislocated twice or more, the shoulder becomes increasingly susceptible to further dislocation and the force or load required to dislocate the shoulder becomes lower. The reason the shoulder is more susceptible to recurrent dislocation when it has become recurrent is because the labrum “bumper” is deficient, and the ligaments that connect the ball to the socket are left in a loosened position. In other words, there is an easier pathway for the ball to keep coming out the front of the socket.
If recurrent dislocations continue, there may be a gradual erosion of the bone of the socket, which may require advanced bone reconstruction, oftentimes with a procedure known as a Latarjet reconstruction. Because the structural damage worsens with each and every dislocation of the joint, sometimes earlier surgery is more beneficial in the long run(2).
Least commonly, some patients with labrum tears that are older or have more recreational athletic demands may be candidates for labrum repair. This is performed to improve symptoms of apprehension with the arm overhead and pain with certain activities. It is important this population be screened for other sources of shoulder pain (including tendon tears and arthritis), because sometimes over-tightening the shoulder with repair when alternative pain sources are present can lead to stiffness.
When is Bankart labrum repair not recommended?
Surgical repair is not recommended for patients at low-risk of recurrent instability including older, recreational athletes. These individuals are often treated with sling immobilization and exercise treatments to strengthen the shoulder in preparation for full return to activity. Additionally, arthroscopic repair is not recommended in patients with a significant dent in the ball, called a Hill-Sachs Lesion, or in those with significant bone loss in the front of the socket. These patients are sometimes best treated with other procedures called remplissage and Latarjet, respectively.
What is the surgery like for arthroscopic Bankart repair?
Arthroscopic Bankart repair is performed as a minimally invasive, outpatient procedure, that generally takes less than one hour to complete. The procedure has a goal restoring anatomy, or repairing the injured tissue back to the glenoid bone donor site. Modern arthroscopic technique takes advantage of “knotless” suture anchors which are low-profile, not irritating to the shoulder, and reliably and reproducibly result in excellent long-term healing outcomes.
Arthroscopic anterior labrum repair is performed under a light general anesthetic and a regional shoulder block that allows the patient to awaken immediately after surgery and leave the facility. A sling is generally maintained for six weeks and return to full activity is permitted generally between 3 and 6 months.
What if I play team sports?
As noted, labrum tears are very common in young athletic patients, particularly those participating in contact sports such as ice hockey and football. These patients often required specialized counseling to help them decide when or if to repair the shoulder, depending on the year in school, demands for return to competitive athletics, and what part of the season the patient injures the shoulder. As an example, a college-bound high school senior football lineman that injures the shoulder in the middle of the senior season may elect to postpone surgical repair until the season is complete, even if returning to play sooner means additional risk of reinjury.
Schedule a shoulder exam
If you’ve suffered a shoulder dislocation and are concerned you may require an orthopedic subspecialist evaluation, call our office, or book an appointment with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer provides expert orthopedic care for patients suffering a shoulder injury. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
- Bankart AS. Recurrent or Habitual Dislocation of the Shoulder-Joint. Br Med J. 1923 Dec 15;2(3285):1132-3. doi: 10.1136/bmj.2.3285.1132. PMID: 20771383; PMCID: PMC2317614.
- Pougès C, Hardy A, Vervoort T, Amouyel T, Duriez P, Lalanne C, Szymanski C, Deken V, Chantelot C, Upex P, Maynou C. Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial. Am J Sports Med. 2021 Apr;49(5):1166-1174. doi: 10.1177/0363546521996381. Epub 2021 Mar 11. PMID: 33705240.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
- Learn more