Bankart Repair (Shoulder Instability)

Why this approach — at MOS

The most consequential decision in treating shoulder instability is not how to perform the Bankart repair — it is determining whether a Bankart repair is the right procedure in the first place. Glenoid bone loss is the single most important variable in predicting recurrence after soft-tissue repair. We obtain high-quality MRI (and CT when bone loss is suspected) on every instability patient before offering surgery.

For patients with less than 15% glenoid bone loss and no engaging Hill-Sachs, arthroscopic Bankart repair with anchor fixation gives excellent results. We typically use three to four knotless anchors placed in an anatomic sequence from the 5 o'clock to the 2 o'clock position, restoring the labral bumper and tensioning the inferior glenohumeral ligament complex.

When the Hill-Sachs lesion is large or in an "off-track" position relative to the glenoid, we add a remplissage at the same setting. This combination — Bankart plus remplissage — significantly reduces re-dislocation risk compared to Bankart repair alone in patients with larger humeral-side defects.

When glenoid bone loss exceeds 20–25% or in patients with multiple prior failed repairs, we recommend the Latarjet procedure over a repeat soft-tissue repair. This is a technically more demanding coracoid transfer procedure, but the evidence for it in high-risk instability patients is clear.

Post-operative rehabilitation follows a structured protocol beginning with passive motion and progressing to active strengthening at 6–8 weeks. Return to contact sport is not permitted before 5–6 months.

Who is a candidate?

Indications

• First-time traumatic shoulder dislocation in a patient under 25 with a confirmed Bankart lesion on MRI
• Recurrent shoulder instability (two or more dislocations or persistent subluxations) at any age
• Shoulder subluxation interfering with sport or work despite physical therapy
• Confirmed Bankart lesion with minimal glenoid bone loss (less than 15–20% of the glenoid width)
• Athletes unwilling to accept high recurrence risk of non-operative management

Contraindications

• Glenoid bone loss greater than 20–25% (Latarjet procedure preferred)
• Active shoulder infection
• Pre-existing severe glenohumeral arthritis
• Large engaging Hill-Sachs lesion that will not be addressed by soft-tissue repair alone (remplissage may need to be combined)
• Voluntary dislocators (psychological component requires separate evaluation)

Conservative Treatment First

Not every first-time dislocation requires immediate surgery, particularly in patients over 30 or those with lower physical demands. After a shoulder dislocation is reduced (put back in place), a brief period of immobilization — typically 1–3 weeks — is followed by supervised physical therapy. Therapy focuses on restoring range of motion and strengthening the rotator cuff and periscapular muscles to provide dynamic stability.

In older patients or low-demand individuals, this approach frequently succeeds. In young, active patients — particularly those who participate in collision sports or overhead athletics — the structural damage from a Bankart lesion makes non-operative success much less likely. The decision to proceed with surgery after a first-time dislocation in a young athlete requires a frank discussion of recurrence risk, the importance of returning to sport, and the timing relative to the upcoming season. Patients in the greater Bethesda area who are evaluated promptly after a dislocation can typically make this decision in consultation with their surgeon within the first two weeks of injury.

The procedure

What Is Bankart Repair?

Bankart repair is an arthroscopic surgery that reattaches the torn anterior labrum and ligaments to the glenoid socket after shoulder dislocation. It restores the labral bumper that keeps the humeral head from slipping out of the socket. Most patients have no further dislocations, and athletes return to sport in 4–6 months.

The shoulder is the most mobile joint in the body and also the most commonly dislocated. When the humeral head (ball) forcefully exits the front of the glenoid (socket), the anterior labrum — a rim of fibrocartilage that deepens the socket — typically tears away from the bone. This injury is called a Bankart lesion. Without surgical repair, the labrum cannot heal to bone reliably, and the capsular ligaments that depend on an intact labrum remain lax. The result is a structurally unstable shoulder that is prone to repeat dislocations.

A first-time dislocation in a young patient carries a recurrence risk of 70–90% with non-operative treatment. In patients over 40, recurrence rates are much lower — under 30% — because the soft tissues become less elastic and the shoulder tends to "tighten up" after injury. Surgery is therefore considered more urgently in young, active individuals and competitive athletes whose shoulder demands are high.

The arthroscopic Bankart repair addresses the labral tear directly, using small anchors and sutures to pull the labrum back against the glenoid rim and restore its anatomic position. When glenoid bone loss exceeds approximately 20–25% — seen in patients with multiple prior dislocations or high-energy injuries — a Latarjet procedure may be more appropriate than a soft-tissue repair alone.

What Happens During Bankart Repair?

Before Surgery

You arrive at the ambulatory surgery center approximately 90 minutes before the procedure. An interscalene nerve block is placed by the anesthesiologist to provide regional anesthesia to the shoulder and arm. This dramatically reduces post-operative pain and allows for lighter general anesthesia.

Positioning

You are positioned in the beach chair or lateral decubitus position with the shoulder exposed. General anesthesia is administered, and the shoulder is cleaned and draped.

Diagnostic Arthroscopy

A small camera is inserted into the glenohumeral joint through a posterior portal. The surgeon inspects the labrum, biceps anchor, articular cartilage, and rotator cuff. The Bankart tear is identified and any associated Hill-Sachs lesion (a dent in the humeral head) is sized and assessed for its clinical significance.

Labral Preparation

The anterior glenoid rim where the labrum has detached is carefully débrided and the bone surface is freshened with a burr to encourage a healing response.

Anchor Placement and Repair

Two to four suture anchors (typically 2.4–3.5 mm knotless or knotted anchors) are placed along the glenoid articular margin. Each anchor has two strands of high-strength suture. A suture-passing device guides the sutures through the labrum and capsule. The sutures are then tensioned and secured, pulling the labrum firmly back to the glenoid rim. The repair is done from inferior to superior, progressively tensioning the inferior glenohumeral ligament — the primary restraint to anterior translation.

Remplissage (If Needed)

If a significant Hill-Sachs lesion is present that could "engage" on the repaired glenoid rim, a remplissage is performed at the same sitting — the posterior capsule and infraspinatus tendon are secured into the Hill-Sachs defect to prevent engagement.

Closure and Recovery Room

Portals are closed and the arm is placed in a sling. You recover for 45–60 minutes before discharge. Most patients leave with the arm numb from the nerve block and are comfortable throughout the first night.

Recovery timeline

Frequently Asked Questions