The Bankart repair is a surgical procedure designed to restore stability to the shoulder after recurrent anterior dislocations. Named after British surgeon Arthur Sidney Blundell Bankart, this procedure has evolved from an open technique in the 1920s to today’s minimally invasive arthroscopic surgeries. Despite technological advancements, the core principles established by Bankart remain foundational in treating anterior shoulder instability.
The History of Shoulder Instability and the Birth of the Bankart Repair
Shoulder dislocations have been recorded since ancient times, with Hippocrates describing early treatment methods in the 5th century BCE. Over the centuries, various techniques were attempted to treat dislocations, but many were either overly aggressive or ineffective at preventing recurrence.
In 1923, Arthur Bankart made a groundbreaking observation: the key lesion in patients with recurrent shoulder instability was a detachment of the labrum—a ring of cartilage—at the front of the shoulder socket (glenoid). His repair method focused on directly addressing this problem, unlike previous techniques that simply tightened surrounding tissues. This insight laid the foundation for modern shoulder stabilization.
The Original Bankart Repair Technique
Bankart’s original method was an open surgical procedure that involved several intricate steps:
- A coracoid osteotomy, where a piece of bone from the coracoid process was temporarily removed.
- A subscapularis tenotomy, involving the careful cutting and later repair of a major shoulder tendon.
- Direct visualization and repair of the detached labrum using silk-based sutures.
He emphasized that the capsule of the shoulder should not be overtightened, as preserving the shoulder’s normal range of motion was crucial.
After surgery, patients were immobilized in a sling for about four weeks before beginning gradual movement exercises. Interestingly, despite publishing surgical techniques and illustrations, Bankart never published his own outcome data. It wasn’t until 1957 that his colleagues reported low recurrence rates and only modest loss of external rotation.
Evolution into Modern Techniques
With advances in arthroscopy, the modern Bankart repair is now mostly performed through tiny incisions using a camera and specialized instruments. Surgeons can now clearly visualize the damaged structures inside the shoulder joint, making repairs more precise and less invasive.
Instead of creating large incisions or removing bone, modern techniques:
- Use suture anchors to reattach the labrum.
- Avoid coracoid osteotomy and subscapularis cutting.
- Offer faster recovery and reduced postoperative stiffness.
Different surgeons use varying techniques, such as knotless suture anchors or specialized instruments for labral mobilization. Despite these variations, the core steps mirror Bankart’s original vision: identify the labral tear, prepare the bone surface for healing, and secure the labrum back to its native position.
Key Differences Between Old and New Approaches
| Aspect | Original Bankart Repair | Modern Arthroscopic Repair |
|---|---|---|
| Approach | Open surgery with large incision | Minimally invasive, arthroscopic |
| Exposure | Coracoid osteotomy, subscapularis tenotomy | Small portals through rotator interval |
| Labrum treatment | Labrum sometimes excised | Labrum preserved and reattached |
| Fixation method | Bone tunnels and sutures | Suture anchors (knotted or knotless) |
| Recovery | 4 weeks in adduction bandage | Sling for 3–4 weeks, earlier rehab |
| Visualization | Limited open view | Full intra-articular visualization |
Though the tools have changed, the goals have not: restore anatomy, preserve function, and prevent recurrent dislocations.
When Is a Bankart Repair Recommended?
A Bankart repair is most suitable for:
- Recurrent anterior shoulder dislocations.
- Young, active patients (especially athletes).
- Patients without significant bone loss in the shoulder socket.
However, if a patient has substantial glenoid bone loss (typically more than 15–20%) or a large Hill-Sachs lesion (a compression injury on the humeral head), additional procedures like bone grafting or remplissage may be needed to ensure success.
Long-Term Outcomes and Modern Challenges
Modern Bankart repairs report high satisfaction and return-to-sport rates, particularly when performed early. However, some patients—especially contact athletes—may experience recurrence. Research is ongoing to determine the ideal candidates and refine techniques further.
Complications are relatively rare but can include:
- Recurrent dislocation.
- Stiffness (less common with arthroscopy).
- Development of osteoarthritis over time.
- Nerve injury (rare and usually temporary).
The Future of Bankart Repair
As technology and imaging improve, surgeons can now personalize treatment strategies using:
- CT and MRI scans to assess bone loss.
- Virtual simulations and even AI tools to predict surgical outcomes.
Looking ahead, a tailored approach based on each patient’s activity level, joint structure, and risk factors will likely define the next era of Bankart repair.
Conclusion
From open surgery in the 1920s to state-of-the-art arthroscopic techniques today, the Bankart repair remains a cornerstone in the treatment of shoulder instability. Thanks to the vision of Arthur Bankart and modern surgical innovation, patients can expect effective and lasting solutions that restore both shoulder stability and mobility.
Do you have more questions?
Q. What is a Bankart lesion?
A. A Bankart lesion is a tear of the labrum, the ring of cartilage that surrounds the socket of the shoulder joint, often caused by shoulder dislocation.
Q. What is Bankart repair surgery?
A. Bankart repair is a surgical procedure that reattaches the torn labrum to the socket to restore stability to the shoulder joint.
Q. When is Bankart repair recommended?
A. Bankart repair is recommended when a patient has repeated shoulder dislocations due to a torn labrum that has not healed with non-surgical treatments.
Q. What are the symptoms of a Bankart lesion?
A. Symptoms may include shoulder instability, pain, a feeling of the shoulder slipping out, weakness, and limited range of motion.
Q. What imaging studies are used to diagnose a Bankart lesion?
A. X-rays and MRI scans are commonly used to diagnose Bankart lesions and assess the extent of injury.
Q. What are the types of Bankart repair surgery?
A. The two main types are arthroscopic Bankart repair and open Bankart repair.
Q. What is arthroscopic Bankart repair?
A. Arthroscopic Bankart repair is a minimally invasive procedure using a camera and small instruments inserted through tiny incisions to reattach the labrum.
Q. What is open Bankart repair?
A. Open Bankart repair involves a larger incision to directly access and repair the torn labrum.
Q. What is the recovery time after Bankart repair?
A. Recovery typically involves several months, with full return to sports or heavy activity taking 4 to 6 months.
Q. What is the postoperative care like after Bankart repair?
A. Postoperative care includes wearing a sling, physical therapy, and gradual return to normal activities under medical supervision.
Q. What are the risks associated with Bankart repair?
A. Risks include infection, stiffness, nerve injury, recurrence of dislocation, and failure of the repair.
Q. How successful is Bankart repair surgery?
A. Bankart repair has a high success rate in restoring stability and preventing recurrent dislocations in most patients.
Q. Can Bankart repair be done on both shoulders?
A. Yes, Bankart repair can be performed on both shoulders if needed, but typically one shoulder is addressed at a time.
Q. What activities should be avoided after Bankart repair?
A. Heavy lifting, contact sports, and overhead movements should be avoided during the initial recovery period.
Q. Will I need physical therapy after Bankart repair?
A. Yes, physical therapy is essential to regain range of motion, strength, and shoulder stability after surgery.
Q. Is general anesthesia used during Bankart repair?
A. Yes, the procedure is typically performed under general anesthesia.
Dr. Vedant Vaksha
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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