Bankart Repair: Restoring Shoulder Stability Through History and Innovation

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.