MediGence: Enabling Better Health Decisions

Shoulder instability is one of the most common problems among athletes, fitness enthusiasts, and individuals who experience everyday wear and tear. Among other causes, a Bankart lesion is one of the most common contributors to instability. This injury will often be fixed with a specific procedure called arthroscopic Bankart repair (a minimally invasive surgery) to restore shoulder stability and provide preventative management of recurrent dislocations.

If you have experienced repeated shoulder dislocations, arm weakness, or have ever felt your shoulder 'slip out of place', you may be wondering if you could be a candidate for this procedure. This blog provides an overview of arthroscopic Bankart repair, including who requires this procedure, some key signs and symptoms to look for, and what patients can expect before and after surgery.

Understanding the Shoulder Joint and Instability

The shoulder is the most mobile joint we have in the body, as it can flex, extend, abduct, adduct, rotate, and circumduct our arms. The mobility of the shoulder helps us complete everyday tasks; however, this mobility is the price we pay to have a stable joint.

The ball-and-socket shoulder joint is defined by the head of the humerus (the upper arm bone) and the glenoid cavity of the scapula (the shoulder blade). The glenoid cavity is a shallow socket in the scapula that is deepened by a ring of cartilage called a labrum, which adds stability to the joint. The joint is also stabilised by ligaments, tendons, and muscles that work together to stabilise the humeral head.

When the shoulder is forced to move beyond normal ranges of motion via trauma, sports injury, or repetitive motions, the humeral head can slip out of the socket, resulting in a dislocation of the shoulder joint. If enough force is generated at the time of dislocation, the labrum may tear. This tear is referred to as a Bankart lesion.

What is a Bankart Lesion?

A Bankart lesion is a tear of the anteroinferior portion of the labrum (the front and bottom part of the socket). A Bankart lesion typically develops after the first dislocation of the shoulder and is more common in younger, active individuals.

Key points regarding a Bankart lesion include:

It destabilises the shoulder joint.
It predisposes the patient to recurrent shoulder dislocations.
It can involve surrounding tissues such as ligaments and cartilage.

If left untreated, a Bankart lesion has an increased likelihood of repeat dislocations, chronic pain and instability.

Arthroscopic Bankart Repair

Arthroscopic Bankart repair is a minimally invasive procedure that utilises small incisions and uses a camera (arthroscope) to assist the surgeon visually. The surgeon reconstructs the torn labrum and reattaches it to the glenoid socket using sutures and anchors.

Benefits of arthroscopic repair:

It involves smaller incisions than a traditional open surgery.
It means less pain and less scarring.
The recovery time is faster.
A greater success rate in restoring stability

Who would benefit from an arthroscopic Bankart repair?

Not every shoulder dislocation requires surgery. Many people (especially older individuals or those with minor injuries) do well with conservative measures such as rest, physical therapy, and lifestyle modifications. However, certain patients are more likely to require surgical treatment.

Recurrent Shoulder Dislocations: The most common reason for surgery is repeated shoulder dislocations after the very first injury. If your shoulder "pops out" more than once, it is an indicator that the labrum has not healed and needs to be repaired.
Young and Active Patients: Patients under thirty years of age are more likely to have repeated dislocations. Athletes who participate in contact sports such as football, rugby, wrestling, or basketball are more likely to require surgical stabilisation.
High-Demand Occupations: Individuals who are involved in physically demanding occupations (e.g., construction workers, military personnel, manual labor) may need surgical repair to restore function completely to prevent impairment in their occupation.
Significant Labral Injury: Imaging, such as MRIs with or without contrast (e.g., MR arthrogram), may show considerable labral tears or concurrent injuries such as Hill-Sachs lesions (indentations in the humeral head). In these instances, conservative care is often ineffective.
Persistent Instability Despite Therapy: If the use of physical therapy, strengthening exercises, and bracing is unable to restore stability, then surgery is generally recommended.
Pain and Functional Limitations: Although some patients may not experience frequent dislocations, they often suffer from persistent pain, weakness, and a fear of movement due to instability. An arthroscopic repair allows for regaining confidence and also improves the quality of life.

Signs and Symptoms of a Bankart Lesion

Recognizing the signs of Bankart Lesion early allows patients to prevent damage and prevent potential permanent injury.

Shoulder Instability: An individual may have a feeling that their shoulder is "slipping", "giving way", or is loose, or fear of specific movements (i.e., overhead or outward rotation).
Recurrent Dislocations: Shoulder dislocations will occur more than once, often requiring less force for subsequent dislocations. Several patients report dislocating their shoulder while sleeping or with simple daily movements.
Pain and Discomfort: Pain can be located in the front of the shoulder, usually with heavy lifting, overhead, or throwing movements. In rare and severe cases, individuals may even feel discomfort at rest.
Weakness: Typically, an individual will feel weakness in their affected arm with pushing and pulling movements. The individual may also be unable to perform tasks related to their sport, similar to individuals having difficulty with heavy lifting.
Decreased Range of Motion: Individuals may feel "stiff" or inflexible when moving their arm as they fear dislocating their shoulder again. For example, activities such as reaching behind their back for an item or throwing a ball may be strenuous because of this "stiff" feeling.
Clicking or Catching Sensation: Some individuals may experience a mechanical "click" or "catching" sensation when moving their arm because of the underlying instability of the labrum.

Bankart Lesion Diagnosis

An accurate diagnosis is imperative before considering an arthroscopic repair:

Clinical Assessment: A doctor will perform a physical examination to assess an individual's shoulder stability, strength, and range of motion. The doctor may use special tests, such as the Apprehension Test or Relocation Test, which can also provide some confirmation of labral instability.
Imaging studies: X-rays will be taken to determine if any fractures are present. An MRI with contrast is also used to evaluate the labrum and any associated injuries, for example, rotator cuff tears. In certain complex cases, a CT scan will be necessary to rule out any bony loss.
The Arthroscopic Bankart Repair: Preparation before surgery. Before surgery, patients undergo a thorough medical evaluation to assess their general health and suitability for surgery. Physical therapy may be recommended in the short term to help strengthen the shoulder.

Surgical Steps

Small incisions are made around the shoulder.
An arthroscope (tiny camera) is placed to visualise what is happening in the joint.
Specialised instruments are used to clean and prepare the torn labrum.
Anchors with sutures are drilled into the glenoid bone.
The torn labrum is sewn back to its original position, using the sutures.
The joint is stabilised in the appropriate amount of time, and incisions are closed.
The surgery takes 60-90 minutes on average and is done under general anaesthesia.

Recovery After Arthroscopic Bankart Repair

Recovery is a stepwise process and requires patience and commitment.

Immediate post-surgery: The arm is placed in a sling for 3-4 weeks to protect the repair. Pain will be managed with medications, as well as ice therapy.
Weeks 1-4: Focus on rest and gentle range of motion exercises for the elbow, wrist, and hand.
Weeks 4-6: Beginning passive range-of-motion under the guidance of a therapist.
Weeks 6-12: Active range of motion, along with gentle strengthening exercises.
Months 3-6: Focus on further strengthening, sport-specific drills, and return to daily activities.
After 6 months, most patients will return to sports, although contact sports may take longer to be cleared.

Success Rates: Studies show excellent success rates (85â€“95%) for preventing future dislocations for arthroscopic Bankart repair, particularly if done early.

Risks and Complications

As with any procedure, an arthroscopic Bankart repair has risks, although they are rare.

Infection
Stiffness or limited range of motion
Nerve injury (infrequent)
Failure of repair or a recurrence of instability
Development of arthritis over long-term (multiple years) follow-up

These risks can be minimised by proper rehabilitation and following medical advice.

Lifestyle and Long-term Expectations

For the majority of patients, the arthroscopic Bankart repair has excellent outcomes. With rehabilitation:

Athletes can return to their sport at a pre-injury level.
Normal daily activities are pain-free and stable.
The likelihood of future dislocation is drastically reduced.
It is still essential to follow precautions such as:
Not practising any high-risk during the initial recovery period.
Doing shoulder muscle strengthening exercises.
Booking follow-up appointments with the orthopedic surgeon.

Conclusion

A Bankart lesion can be a very frustrating and painful condition, especially for athletes and active people. Shoulder dislocations, instability, pain, and weakness are common indicators that you may need surgery. Arthroscopic Bankart repair is a minimally invasive and highly effective way to repair the Bankart lesion, restoring stability, reducing pain, and enabling patients to return to normal activities.

If you have recurrent shoulder dislocations or persistent instability, the first step on the road to recovery is to see an orthopedic specialist. With a swift diagnosis and treatment, you can restore your strength, minimise damage, and maintain a stable, pain-free shoulder.