Arthroscopic Bankart Repair Procedure: A Detail Guide

Shoulder dislocations can be painful and frustrating, often leading to recurring instability. One of the most common injuries associated with shoulder dislocations is a Bankart lesion, a tear in the labrum at the front of the shoulder socket. If left untreated, it can lead to chronic instability and repeated dislocations.

One of the most effective treatments for this condition is the arthroscopic Bankart repair, a minimally invasive procedure that restores stability to the shoulder. This procedure involves reattaching the torn labrum to the glenoid (shoulder socket) using small anchors and sutures.

In this article, we’ll explore everything you need to know about the arthroscopic Bankart repair procedure, including the causes of Bankart lesions, the surgical process, recovery, and rehabilitation.

Understanding Bankart Lesions

Definition and Causes

A Bankart lesion occurs when the labrum (a ring of cartilage around the shoulder socket) is torn due to a dislocation or subluxation (partial dislocation) of the shoulder. The injury most commonly happens in young athletes and active individuals involved in contact sports such as football, basketball, and wrestling.

Common causes of a Bankart lesion include:

• Traumatic shoulder dislocations (falling on an outstretched arm, sports injuries)
• Repetitive overhead activities (swimming, baseball pitching, weightlifting)
• Previous shoulder instability or hypermobility

How Bankart Lesions Affect Shoulder Stability

The labrum plays a critical role in keeping the ball of the humerus (upper arm bone) securely within the glenoid socket. When a Bankart lesion occurs, the shoulder loses its natural stability, making future dislocations more likely.

Symptoms and Diagnosis

Common symptoms of a Bankart lesion include:

• Persistent shoulder instability or a feeling of looseness
• Recurrent shoulder dislocations
• Pain during movement, especially overhead motions
• Clicking or popping sounds in the shoulder
• Weakness and reduced range of motion

Diagnosis

A doctor typically diagnoses a Bankart lesion through:

• Physical examination: Checking shoulder stability, strength, and range of motion
• Imaging tests: MRI (often with contrast dye) and X-rays to confirm labral damage and rule out fractures

Indications for Arthroscopic Bankart Repair

When is Surgery Recommended?

While some minor Bankart lesions may heal with physical therapy and rest, surgery is often recommended in the following cases:

• Recurrent shoulder dislocations
• Significant instability affecting daily activities
• Athletes or physically active individuals who need full shoulder function
• Failure of non-surgical treatments

Non-Surgical vs. Surgical Treatment

• Non-Surgical: Physical therapy, anti-inflammatory medications, and activity modifications may help in mild cases.
• Surgical: Arthroscopic Bankart repair is considered when instability persists, or a patient wants to return to high-demand activities.

Ideal Candidates for the Procedure

The best candidates for arthroscopic Bankart repair include:

• Young athletes (especially under 30 years old)
• People with frequent shoulder dislocations
• Individuals with no significant bone loss or arthritis in the shoulder

Preoperative Preparation

Initial Consultation and Evaluation

Before surgery, the orthopedic surgeon will:

• Review the patient’s medical history and previous injuries
• Conduct a thorough physical examination
• Discuss expectations and potential risks

Imaging and Diagnostic Tests

Common tests before surgery include:

• MRI Scan: To assess the severity of the labral tear
• X-rays: To check for fractures or bone loss in the glenoid

Preparing Mentally and Physically for Surgery

To ensure a smooth surgery and recovery, patients should:

• Stop smoking (as it can slow healing)
• Avoid anti-inflammatory medications that may increase bleeding
• Arrange for post-surgical assistance (someone to help at home)
• Practice one-handed activities (since the arm will be in a sling post-surgery)

Step-by-Step Procedure of Arthroscopic Bankart Repair

1. Anesthesia and Patient Positioning

   • The patient is placed under general anesthesia or a nerve block to numb the shoulder.
   • The surgeon positions the patient in either the beach-chair position (sitting upright) or lateral decubitus position (lying on the side).

2. Creating Access Points (Portals)

   • Small incisions (portals) are made to insert the arthroscope (tiny camera) and surgical instruments.

3. Visualizing the Shoulder Joint with Arthroscopy

   • The arthroscope provides a clear view of the labral tear and surrounding tissues on a monitor.
   • Saline solution is used to expand the joint for better visibility.

4. Cleaning and Preparing the Labrum

   • The torn labrum and surrounding damaged tissue are cleaned and prepared for reattachment.

5. Anchoring the Labrum Back to the Glenoid

   • The surgeon uses suture anchors (tiny screws with attached sutures) to reattach the labrum to the glenoid.
   • The sutures are carefully tied to hold the labrum in place.

6. Closing and Post-Surgical Care

   • The incisions are closed with stitches or surgical tape, and the shoulder is placed in a sling to protect the repair.

Recovery Timeline After Arthroscopic Bankart Repair

Recovering from arthroscopic Bankart repair requires patience and dedication to rehabilitation. The timeline can vary, but most patients go through distinct phases of recovery.

Immediate Post-Surgery Expectations (First Few Days)

• The shoulder is immobilized in a sling for 4 to 6 weeks to allow healing.
• Pain and swelling are managed with ice therapy, prescribed pain medications, and anti-inflammatory drugs.
• Movements of the operated arm are strictly limited, with only slight passive movements allowed.

Early Recovery Phase (Weeks 1–6)

• Patients begin gentle passive range of motion (ROM) exercises under the guidance of a physical therapist.
• Avoid any lifting, pushing, or pulling with the affected arm.
• Focus is on reducing swelling and maintaining flexibility.

Intermediate Recovery Phase (Weeks 6–12)

• The sling is removed, and active-assisted ROM exercises begin.
• Gradual strengthening of shoulder muscles using light resistance bands and weights.
• Continued avoidance of high-impact activities or overhead movements.

Advanced Recovery Phase (Months 3–6)

• Progressive strengthening exercises to restore full range of motion and stability.
• Sport-specific exercises may begin, depending on healing progress.
• Return to low-impact sports and activities around 4 to 5 months post-surgery.

Full Recovery and Return to Sports (6+ Months)

• Most athletes can return to competitive sports after 6–9 months.
• Strength, endurance, and flexibility should be restored before resuming high-impact activities.

Rehabilitation and Physical Therapy

Physical therapy plays a crucial role in regaining strength, mobility, and function after surgery.

Phase 1: Immobilization and Passive Motion (Weeks 0–6)

• Goals: Minimize pain, protect the repair, and prevent stiffness.
• Exercises:
  • Pendulum exercises
  • Assisted forward elevation
  • External rotation with a therapist’s help

Phase 2: Active-Assisted and Active Motion (Weeks 6–12)

• Goals: Increase ROM and begin gentle muscle activation.
• Exercises:
  • Active-assisted range of motion (AAROM) exercises
  • Light resistance band work for rotator cuff muscles
  • Scapular strengthening exercises

Phase 3: Strengthening and Functional Training (Months 3–6)

• Goals: Restore normal strength and stability.
• Exercises:
  • Dumbbell shoulder presses (light weight)
  • Internal and external rotation exercises
  • Proprioception drills for improved shoulder control

Phase 4: Return to Sports and Full Function (Months 6–9)

• Goals: Prepare for return to sports or demanding activities.
• Exercises:
  • Sport-specific training
  • Plyometric drills (e.g., medicine ball throws)
  • Resistance training with heavier weights

Potential Risks and Complications

While arthroscopic Bankart repair is highly effective, like any surgery, it comes with risks.

Common Surgical Risks

• Infection: Rare but possible, treated with antibiotics if needed.
• Bleeding or blood clots: Uncommon, but patients with clotting disorders are at higher risk.
• Stiffness or frozen shoulder: Can occur if post-surgical rehab is delayed.

Possible Complications

• Recurrent instability: In some cases, the repair may fail, leading to another dislocation.
• Nerve or blood vessel injury: Rare, but can cause numbness or weakness.
• Failure of suture anchors: If anchors pull out, revision surgery may be needed.

When to Seek Medical Help

• Severe pain not relieved by medication
• Increased swelling, redness, or discharge from incisions
• Loss of sensation or movement in the arm

Success Rate and Long-Term Outcomes

Arthroscopic Bankart repair has a high success rate, especially in younger, active individuals.

Expected Recovery Results

• Over 85–90% of patients regain full shoulder stability.
• Most people return to daily activities within 3 months.
• Full sports participation is usually possible by 6–9 months.

Success Rates of the Procedure

• Studies show a recurrence rate of only 10–15% in properly selected patients.
• Patients who follow rehab protocols strictly have better long-term outcomes.

Long-Term Shoulder Stability and Strength

• With proper rehab, shoulder function can return to pre-injury levels.
• Strengthening the rotator cuff and scapular muscles is essential to prevent future injuries.

Preventing Future Shoulder Dislocations

After undergoing an arthroscopic Bankart repair, preventing future dislocations is crucial for maintaining long-term shoulder health.

Strengthening Exercises for the Shoulder

• Rotator cuff strengthening: External/internal rotation with resistance bands.
• Scapular stabilization: Shoulder blade squeezes and wall push-ups.
• Core and upper body strength training: A strong core helps stabilize the shoulder.

Activity Modifications

• Avoid repetitive overhead activities until fully healed.
• Gradually increase intensity when returning to sports.
• Use proper form and technique when lifting weights.

Tips for Athletes and Active Individuals

• Warm up and stretch before workouts.
• Wear protective gear if engaging in high-contact sports.
• Follow progressive rehab programs designed for athletes.

Frequently Asked Questions (FAQs)

1. How long does it take to recover from arthroscopic Bankart repair?

Recovery typically takes 6–9 months, with full range of motion returning around 3–4 months post-surgery. Athletes may need longer rehab before returning to sports.

2. When can I return to sports after the procedure?

Most non-contact sports can be resumed after 4–5 months, while contact sports or heavy lifting should be avoided for at least 6–9 months.

3. Will my shoulder be as strong as before?

Yes, if proper rehab and strengthening exercises are followed, shoulder strength and stability can return to pre-injury levels. However, avoiding future injuries is crucial.

4. Are there alternatives to surgery for a Bankart lesion?

Non-surgical treatments like physical therapy, rest, and anti-inflammatory medications may help minor cases, but surgery is the best option for recurrent dislocations.

5. How can I prevent a recurrence of shoulder dislocation?

Strengthening the rotator cuff and scapular muscles, avoiding excessive strain, and following a structured rehab program are key to preventing future dislocations.

Conclusion

Arthroscopic Bankart repair is a highly effective procedure for restoring shoulder stability and function after recurrent dislocations. With a structured recovery plan, physical therapy, and strength training, most patients achieve full recovery and return to their active lifestyles.

If you or someone you know is struggling with shoulder instability, consulting an orthopedic specialist can provide the best course of action. By committing to post-surgical care and rehabilitation, you can ensure long-term shoulder health and prevent future injuries.