What is a Bankart Lesion (tear)?
A Bankart lesion is a tear of the anterior glenoid labrum (rim surrounding the socket) associated with anterior shoulder dislocations. In a Bankart lesion there is detachment of the anteroinferior labrum (typically at the 3 o’clock to 6 o’clock position). If the lesion is associated with bone detachment, it is called a bony Bankart lesion when some of the glenoid bone is broken off with the anterior labrum. A bony Bankart potentially leaves the shoulder joint more unstable due to the loss of the labrum and the loss of bone.
How does a Bankart Lesion (tear) occur?
Bankart lesions are injuries associated with people who have had a shoulder dislocation and sustained a particular type of labrum injury as a result. Bankart lesions are frequently the result of high energy trauma or sports injuries and can be acute injuries such as a sports collision (rugby tackle) or in a car accident where the impact forces or pulls the shoulder out of alignment causing a dislocation. They can occur due to repetitive arm motions for example in swimmers, tennis players, gymnasts and weight lifters resulting in anterior instability. Bankart lesions can also be sustained by falling and landing on one’s shoulder with enough force to dislocate the shoulder such as a fall from a ladder or tripping over and landing on a hard surface.
Though anyone can sustain this injury, young people in their twenties are most susceptible.
How is a Bankart Lesion diagnosed?
This is based on the mechanism of injury and a careful clinical examination. The surgeon may request a standard MRI scan or sometimes request a special scan with contrast (dye) in the joint such as an MR arthrogram or CT arthrogram.
How is a Bankart Lesion treated? Surgical vs Non-Surgical Management
This can be treated conservatively through physiotherapy however in younger patient groups and those involved in collision contact sports or activities where the arm is frequently abducted and externally rotated (lifted sideways away from the torso twisted such that the forearm is pointing vertically) are at risk of recurrent episodes of dislocation or instability. In such cases often an arthroscopic (keyhole) repair of the labrum is performed which stabilises the shoulder. This is called an arthroscopic Bankart repair or anterior shoulder stabilisation.
How is a Bony Bankart lesion treated?
If a small portion of the anterior glenoid is fractured along with the anterior labral tear this is referred to as a Bony Bankart Lesion. The joint is significantly less stable and usually requires early surgical fixation. Depending on the size of the bone fragment the procedure may be performed arthroscopically or for larger fragments through a small anterior incision and either fixing the bone fragment or replacing it with a block of bone.
Post-operatively the shoulder will be immobilised and protected in a sling usually for about 4-6 weeks but depending on the extent of the tear or associated fracture the surgeon may decide to continue with this for longer.
Following surgery a tailored rehabilitation programme with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.