Arthroscopic Bankart Reconstruction
Treatment of Bankart Tears
In my opinion, most Bankart tears or Bankart lesions in young active patients following a dislocation should be treated operatively. This is because the labrum has a very low likelihood of healing and the redislocation rate is 80-90% without surgery in young patients. Surgical treatment has a 90-95% success rate. When an athlete dislocates their shoulder in season, having surgery or continuing to play is a difficult decision. Depending on the age and level of play, time in season, and player and family desires, it is possible to continue play and consider surgical repair at the end of a season. This may be done if there is adequate range of motion, strength, and stability. A shoulder brace or harness may be worn in some sports and positions. There is a risk of recurrent dislocation, which may cause further damage to the shoulder that can have lasting effects.
Dr. Khalfayan’s Tip: The decision to have surgery is a significant one for an athlete and is more difficult if it impacts play during a season. The athlete and family should understand that there is a chance of damaging the labrum more and also damaging the joint surface (articular) cartilage with repeat dislocations. This can lead to poor quality labral tissue for repair or arthritic changes of the shoulder. The risk varies widely and is very individual. I recommend that patients consult with an experienced sports medicine specialist.
Surgery consists of repair of the labrum to the glenoid (socket) in addition to tightening the joint capsule, which is usually stretched out. This is called a Bankart Reconstruction and my preference is to do this arthroscopically. Arthroscopy uses small incisions and allows the surgeon to view the shoulder joint on a TV monitor.
This is a very precise way to use small instruments to perform the surgery without a large incision and without cutting into the rotator cuff tendon called the Subscapularis. Subscapularis dysfunction can occur in as many as 23-70% of open Bankart Reconstructions resulting in weakness or atrophy of the shoulder. Arthroscopic surgery also has the advantage of less pain and easier rehabilitation than open surgery using large incisions.
Repair of the labrum involves creating bleeding of the bone on the edge of the socket where the labrum tore away and placing suture anchors in the bone to tie the labrum down to it. The surgery is done as an outpatient procedure allowing patients to go home the same day.
Close-up of Bankart lesion in a left shoulder after it is prepared for repair
Repaired Bankart Lesion
Rehabilitation of Bankart Tears
The rehabilitation following a Bankart Reconstruction usually takes 4-6 months depending on the sport or activity level. My approach to rehabilitation of surgical repair of Bankart lesions here in Seattle is to use a shoulder immobilizer with a small pillow next to the side to protect the repair for the first six weeks.
Physical therapy is started 1 week after surgery and involves passive range of motion where the therapist moves the shoulder within a specified range. Active motion where the patient starts moving the shoulder without assistance begins at 6 weeks after surgery. There is a progression to more aggressive strengthening at three to four months after surgery and return to some sports at four to six months after surgery. Return to pitching typically takes ten to twelve months and swimming eight to ten months after surgery. It is important to recognize that return to sport is based on multiple factors including biologic healing, return of strength and endurance, subjective improvement, and a gradual/incremental return to sport specific activities. Therefore, return to sport timeframes may vary.
Dr. Khalfayan’s Tip: Sleeping is difficult after surgery. It’s helpful to sleep in a semi-reclining position propping yourself up on pillows behind your head, neck, and upper back or in a recliner until you are comfortable sleeping flat in bed.