Arthroscopy
Bankart Lesion/Labrum Repair
One of the shoulder's main parts is the ball-and-socket configuration that allows you to rotate your arm. In a healthy shoulder joint, the ball and socket remain in stable positions, with the ball (humeral head) centred in the shallow socket (glenoid or glenoid cavity).
Reinforcing this stability is the glenoid labrum, a fibrocartilaginous rim that encircles the glenoid's edge, making its concavity deeper.
Different ligaments surrounding the joint (some attached to the glenoid labrum) help hold the humeral head inside its socket. Together, these bones and tissue keep your shoulder in place and stable through a wide range of motion.
Sometimes, however, a sudden shoulder injury or overuse can create a forceful dislocation that tears the shoulder's cartilage and ligaments when you tear your glenoid labrum below the centre anterior (front) of the socket, this is called a Bankart lesion. When the labrum is torn, the cartilage rim around the socket is compromised, allowing the humeral head to slip farther than normal.
Most Bankart lesions are caused by anterior dislocations — when the arm moves too far forward and down, often when the arm is extended to the side. Posterior dislocation (when the arm is forced backwards) can also lead to a tear in the labrum, though less commonly.
If a fracture accompanies your tear in the bone of the shoulder blade (scapula) or the shoulder socket (glenoid cavity), this is called a bony, or osseous, Bankart lesion.
An untreated Bankart lesion can lead to chronic shoulder instability — meaning your shoulder may dislocate again in the future, probably in situations involving less force than the original injury.
Causes
Bankart lesions are frequently the results of collisions, accidents, and sports injuries (either acute injuries or overuse injuries from repetitive arm motions). Though anyone can sustain this injury, young men in their twenties are most susceptible.
Possible causes of shoulder dislocations and lesions:
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Car accidents: A sudden blow to the shoulder can knock the ball from its socket, tearing the labrum.
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Sports collisions: Crashing into another person with speed and force — for example, during a football or hockey tackle — can shove the shoulder out of alignment or drag the arm forward or backwards, leading to dislocations.
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Falls from sports: Falling and landing on one's shoulder can lead to shoulder dislocations in athletes, especially in sports where falling with height or speed is common, like gymnastics, skating, rollerblading, or skiing.
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Falls (not from sports): Falling off a ladder or tripping on a crack in the sidewalk can deliver enough force to dislocate the shoulder. Older adults and those with gait problems can be highly susceptible to these types of falls.
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Overuse injuries: In some athletes, overuse of the shoulder can lead to loose ligaments and instability. Swimmers, tennis players, volleyball players, baseball pitchers, gymnasts, and weight lifters are prone to this problem. Also, non-athletes may develop instability from repeated overhead motions of the arm (for example, swinging a hammer).
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Loose ligaments: Some people have a genetic predisposition to lose ligaments throughout the body (e.g., double-jointed individuals). They may find that their shoulders pop out of alignment easily.
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Physical abuse: Domestic violence, physical bullying, or fighting can involve falls, blows, or sudden wrenching movements that may pull the ball from the socket, damaging surrounding tissue.
Symptoms
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Pain: when reaching overhead activity like through ball, combing hair.
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Instability and weakness: The shoulder may "just hang there," pop out of the joint, or feel too loose.
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Limited range of motion: Sudden difficulty moving the shoulder in any direction may indicate a tear.
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Unusual noises or sensations in the shoulder.
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Grinding, catching (not moving fluidly), locking in place, or popping can all be symptoms of torn tissue getting caught in the joint.
Treatment
Non-Surgical
For older patients or those who are less active, non-surgical treatment is recommended for a Bankart lesion.
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The arm is immobilized in a sling for a few weeks, usually with the arm resting across the front of the body in internal rotation (turned inwards) and a small pillow under the armpit to hold the arm slightly away from the body. This is then followed by intensive physical therapy to regain the shoulder's strength, stability, and mobility. One of the problems with this treatment method is that the glenoid labrum in this rest position tends to heal in slightly the wrong place, so the socket depth is reduced, making the shoulder more prone to recurrent dislocations.
Surgical
Bankart repair surgery tends to be the treatment of choice for younger patients with a Bankart lesion, especially those who play sports, as there is a high risk of the shoulder dislocating again. This is because the glenoid labrum tear often fails to heal properly, so doesn’t provide the extra depth to the socket that is needed, reducing the stability and increasing the risk of further dislocation.
A Bankart lesion repair is usually carried out arthroscopically (keyhole surgery) under general anaesthesia. The labral tear surgery aims to repair and tighten overstretched and damaged ligaments, joint capsule and cartilage. Suture anchors are placed in the bone, and the torn glenoid labrum is reattached to the glenoid fossa. You can usually go home the same day or the following day after a Bankart repair.
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A sling will need to be worn (including when you sleep) to protect the shoulder for the first few weeks and allow it to heal in the correct position. Physical therapy will be started almost immediately to regain strength, stability and movement. You will be given a rehab programme to follow, progressing to more challenging exercises over time. It usually takes around 4-6 months to recover completely from a Bankart repair and return to contact sports.