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.

How Common It Is and Who Gets It? (Epidemiology)

Recurrent shoulder dislocations are common in young, active individuals, particularly athletes involved in contact sports. The Bankart repair is most commonly performed in patients who have experienced multiple anterior dislocations and are at risk of further instability. While the procedure is beneficial for individuals of all ages, it is particularly effective in younger patients who are physically active and wish to return to sports.

Why It Happens – Causes (Etiology and Pathophysiology)

Anterior shoulder dislocations occur when the ball of the shoulder joint (the humeral head) is forced out of its socket (the glenoid). In many cases, the labrum, a ring of cartilage around the glenoid, is torn during the dislocation. If not properly healed, this tear can result in recurrent dislocations. Bankart’s original observation that labral detachment is the key issue in recurrent instability remains the basis for the Bankart repair today.

How the Body Part Normally Works? (Relevant Anatomy)

The shoulder joint is a ball-and-socket joint, where the humeral head fits into the glenoid cavity of the scapula. The labrum, a fibrocartilaginous ring, helps stabilize the joint by deepening the glenoid. Ligaments and muscles around the shoulder also contribute to its stability. When the labrum is torn during dislocations, the shoulder loses its normal stability, leading to recurrent dislocations and pain.

What You Might Feel – Symptoms (Clinical Presentation)

Patients with recurrent shoulder dislocations often experience pain, weakness, and a feeling of instability, particularly when raising the arm or during overhead motions. The shoulder may also feel like it is “slipping” out of place, especially during activities that require forceful or repetitive movement. As the condition worsens, episodes of dislocation become more frequent and may occur with minimal trauma.

How Doctors Find the Problem? (Diagnosis and Imaging)

A thorough clinical examination is crucial for diagnosing anterior shoulder instability. X-rays are typically taken to rule out fractures or other bone abnormalities. MRIs or MR arthrograms are used to visualize soft tissues like the labrum and to confirm the presence of tears. A positive result will show labral tears or detachment, especially on the anterior part of the glenoid.

Classification

Bankart lesions are classified based on the extent of the labral tear. A classic Bankart lesion refers to a tear of the anterior labrum, often accompanied by damage to the capsule and ligaments. In cases with significant bone loss, such as a large Hill-Sachs lesion (compression fracture on the humeral head), the injury is more complicated and may require additional procedures beyond the Bankart repair.

Other Problems That Can Feel Similar (Differential Diagnosis)

Recurrent shoulder instability can be mistaken for other shoulder conditions such as rotator cuff tears, labral tears not associated with dislocations, or acromioclavicular joint injuries. Differentiating between these conditions requires detailed imaging and careful physical examination to assess the specific area of pain and dysfunction.

Treatment Options

Non-Surgical Care

• Physical therapy to strengthen the shoulder muscles and improve stability
• Activity modification to prevent further dislocations
• Anti-inflammatory medications for pain management

Surgical Care

• Bankart repair, which reattaches the torn labrum to the glenoid using suture anchors
• In cases with significant bone loss, additional procedures like bone grafting or remplissage may be required to address joint instability

Recovery and What to Expect After Treatment

Post-surgery, patients typically wear a sling to protect the shoulder during the healing phase. Physical therapy begins shortly after to restore strength and mobility. Full recovery from a Bankart repair generally takes around 4 to 6 months, with most patients returning to normal activities and sports after completing rehabilitation.

Possible Risks or Side Effects (Complications)

Complications are rare but can include recurrent dislocations, stiffness, nerve injury (temporary), and osteoarthritis over time. The risk of recurrent dislocations is higher in patients with substantial bone loss or those who do not adhere to their rehabilitation program.

Long-Term Outlook (Prognosis)

The long-term prognosis for patients undergoing a Bankart repair is excellent, particularly when the surgery is performed early and the patient follows a structured rehabilitation plan. Most patients can return to sports and daily activities without further dislocations. However, the risk of recurrence increases in patients with significant bone loss or those who do not fully rehabilitate.

Out-of-Pocket Costs

Medicare

CPT Code 29806 – Arthroscopic Bankart Repair (Shoulder Labral Repair for Instability): $250.66

CPT Code 23455 – Open Bankart Repair (Shoulder Labral Repair with Open Technique): $229.47

Medicare Part B typically covers 80% of the approved cost for these procedures once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, reducing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work alongside Medicare to fill the coverage gap and reduce your financial responsibility.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans typically cover any remaining balance, including coinsurance or small deductibles, which generally range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your Bankart repair is required due to a work-related injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your shoulder injury requiring Bankart repair is related to an automobile accident, No-Fault Insurance will typically cover the total cost of treatment, including surgery and recovery. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.

Example

Emma Harris had a shoulder dislocation and required arthroscopic Bankart repair (CPT 29806). Her estimated Medicare out-of-pocket cost was $250.66. Since Emma had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.

Frequently Asked Questions (FAQ)

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.

Summary and Takeaway

The Bankart repair is a cornerstone procedure for treating recurrent shoulder dislocations. Named after Arthur Bankart, the procedure has evolved over the decades from an open surgery to the modern, minimally invasive arthroscopic technique. With proper treatment and rehabilitation, most patients can expect excellent long-term outcomes, including the ability to return to sports and normal activities. However, the success of the procedure depends on early intervention and the severity of underlying conditions like bone loss.

Clinical Insight & Recent Findings

A recent study systematically reviewed the outcomes of arthroscopic Bankart repair in patients aged 30 years and older, focusing on return-to-sport rates and postoperative complications.

The review found that while middle-aged patients show good to excellent outcomes, with a low complication rate (5.4%), some deficits in external rotation and forward flexion were observed postoperatively. Notably, patients with traumatic shoulder instability had a significantly higher rate of returning to their preinjury level of sport (72.9%), compared to those with atraumatic instability.

These results align with the conclusion that arthroscopic Bankart repair remains a valuable treatment option for patients over 30, though further studies are needed to refine surgical techniques and rehabilitation protocols for this age group. (“Study on arthroscopic Bankart repair in older patients – see PubMed.“)

Who Performs This Treatment? (Specialists and Team Involved)

Orthopedic surgeons specializing in sports medicine and shoulder injuries typically perform the Bankart repair. A multidisciplinary team, including physical therapists, plays an essential role in post-operative rehabilitation.

When to See a Specialist?

It’s important to consult a specialist if you have recurrent shoulder dislocations or instability, especially if conservative treatments like physical therapy and rest have not been effective.

When to Go to the Emergency Room?

If you experience a traumatic injury with severe pain or signs of nerve damage (e.g., numbness, tingling), seek immediate emergency care.

What Recovery Really Looks Like?

After Bankart repair, recovery involves a period of rest in a sling, followed by a gradual rehabilitation program focused on restoring strength and range of motion. Most patients can return to daily activities within a few months, with a full return to sports typically occurring after 4 to 6 months.

What Happens If You Ignore It?

Left untreated, recurrent shoulder dislocations can lead to further damage to the labrum, rotator cuff, and bones, increasing the risk of arthritis and chronic instability.

How to Prevent It?

To prevent recurrent dislocations, it is essential to avoid high-risk activities and follow a rehabilitation program that strengthens the shoulder muscles and improves stability.

Nutrition and Bone or Joint Health

A diet rich in calcium and vitamin D can support joint health, reduce inflammation, and promote healing after surgery. Omega-3 fatty acids also have anti-inflammatory properties that may help in recovery.

Activity and Lifestyle Modifications

Patients recovering from a Bankart repair should avoid high-risk activities that may lead to re-injury, especially contact sports. Focus on strengthening the rotator cuff and maintaining shoulder mobility to prevent future instability.