A Bankart repair is a specialized surgical procedure designed to restore stability to the shoulder joint following a traumatic injury. This operation involves reattaching damaged soft tissues, primarily the ligaments and cartilage, back to the rim of the shoulder socket. The goal of the procedure is to prevent the ball of the upper arm bone from repeatedly slipping out of the joint, addressing chronic shoulder instability.
Understanding the Bankart Lesion and Shoulder Instability
The shoulder is a highly mobile ball-and-socket joint, where the head of the humerus (the ball) rests within the glenoid (the socket) of the shoulder blade. This inherent mobility comes at the expense of bony stability, making the joint heavily reliant on surrounding soft tissues for support. A crucial structure providing this stability is the labrum, a ring of fibrocartilage that encircles the glenoid rim, effectively deepening the socket and creating a suction seal to hold the joint together.
A traumatic shoulder dislocation, particularly an anterior (forward) one, can forcefully tear the labrum and the attached ligaments away from the front-lower edge of the glenoid. This specific injury is known as a Bankart lesion, and it is the most common anatomic injury leading to recurrent instability. When the labrum tears away, it removes the natural bumper that prevents the humeral head from sliding forward, allowing the shoulder to repeatedly dislocate or feel loose.
In some instances, the force of the dislocation is strong enough to not only tear the soft tissue but also to fracture a piece of the glenoid bone itself. This more severe condition is termed a Bony Bankart lesion and presents a greater challenge to joint stability. The resulting damage significantly compromises the joint’s function, often requiring surgical restoration.
The Surgical Repair Process
The Bankart repair aims to anatomically restore the torn labrum and capsule to their correct position on the glenoid rim. Surgeons have two primary methods for performing this procedure: the arthroscopic approach or the open approach. Arthroscopic repair is minimally invasive, using a small camera and instruments inserted through several tiny incisions around the shoulder. This technique is often preferred because it results in less soft tissue damage, reduced scarring, and a potentially quicker initial recovery compared to open surgery.
During the arthroscopic procedure, the surgeon first prepares the glenoid rim, gently roughening the bone surface to promote healing of the reattached tissues. They then insert specialized devices called suture anchors into the bone of the glenoid socket. These anchors are small implants, typically made of strong plastic or bioabsorbable material, that have high-strength sutures attached to them.
The surgeon uses the sutures to capture the torn labrum and joint capsule, pulling the detached tissue firmly back into contact with the bone. By knotting the sutures, the tissue is secured against the glenoid rim, essentially recreating the stabilizing bumper that was lost during the injury. This restoration of the labrum and capsule re-tensions the ligaments, which is necessary to prevent future dislocations.
An open Bankart repair involves a single, larger incision on the front of the shoulder, providing the surgeon with a direct view of the joint structures. While the open technique is more invasive, it may be necessary in cases where there is significant bone loss from a Bony Bankart lesion or when there are other complex injuries. The open approach allows for more precise manipulation of the tissues and is sometimes combined with a procedure like the Latarjet when bone loss exceeds 20% of the glenoid surface.
Rehabilitation and Recovery Timeline
The success of a Bankart repair depends heavily on a structured rehabilitation program, which begins immediately following the surgery. In the first four to six weeks, the primary goal is to protect the repair site, and the arm is typically immobilized in a sling. During this initial phase, patients begin gentle, passive exercises for the wrist and elbow, and may perform supported pendulum movements to prevent stiffness without stressing the repair.
Physical therapy progresses in stages, focusing first on regaining passive range of motion, where the therapist or the patient’s other arm moves the operated arm. By approximately six weeks, the patient usually starts active range of motion, beginning to move the arm using their own muscles. Strengthening exercises for the rotator cuff and surrounding muscles begin between six and twelve weeks, building up power and endurance.
Adherence to this progressive protocol helps achieve the best outcome and minimizes the risk of re-injury. Light activities, such as driving, may be resumed around six weeks, but heavy lifting or overhead work is avoided for several months. A full return to contact sports or activities involving forceful arm movements is restricted until six months after the operation, once strength and stability have been fully regained.