BANKART REPAIR

Method: Arthroscopic stabilisation after an anterior shoulder dislocation

Duration: about 60 minutes

Recovery time: 3 to 6 months

What is a Bankart repair?

The Bankart repair is an arthroscopic procedure for treating anterior instability of the shoulder, usually after repeated dislocation. The detached capsulolabral complex is reattached to the socket of the joint (the glenoid) in order to restore the natural stability of the shoulder joint.

Indications for a Bankart repair

Recurrent anterior dislocations of the shoulder
A detached labrum (Bankart lesion) after an injury
Instability of the shoulder despite conservative treatment
Sporting, active patients at high risk of recurrence

How the operation proceeds

Arthroscopic operation under general anaesthetic
Inspection of the shoulder joint and exposure of the Bankart lesion
Mobilisation and reattachment of the labrum to the glenoid with suture anchors
Additional capsular plication possible where there is hyperlaxity
Minimal damage to the soft tissue and rapid wound healing

Recommended timing for a return

Activity	When
Driving	after 6 weeks
Everyday life without the sling	after 6 weeks
Strength training without overhead movement	from 3 months
Overhead sport	4-5 months at the earliest
Full clearance for competition	5-6 months (longer for contact sport)

Rehabilitation after a Bankart repair

Phase 1: protection & passive mobilisation (0-3 weeks)

Aims

Protecting the reconstructed labrum and capsule
Reducing pain and swelling
Preserving movement within the safe range

Measures

Abduction pillow: 24 h a day for 5-6 weeks
Passive movement (by the therapist or a motorised splint): flexion to 60°, abduction to 60°, external rotation in the neutral position 0°
Isometric exercises (pain-free): scapular stability (scapula setting), isometric internal and external rotation, flexion and extension
No active lifting of the arm above shoulder height
No traction or outward rotational stress

Phase 2: transition to active movement (6-8 weeks)

Aims

Restoring active movement
Beginning functional stability
Preserving the integrity of the repair

Measures

Reducing use of the abduction pillow from week 7
Active-assisted to active movement: flexion to 90°, abduction to 90-100°, external rotation to 20-30° at 0° of abduction
Strengthening: rotator cuff with light resistance (resistance band level 1), scapular stabilisation (rhomboids, serratus, trapezius)
No supporting weight on the arm (e.g. a push-up position)
No throwing, snatching or abrupt pulling

Phase 3: building up strength and co-ordination (9-12 weeks)

Aims

Restoring full everyday function
Improving the strength of the rotators and scapular control
A reliable range of movement

Measures

Active movement largely free, external rotation increased carefully to 45-60°
Concentric and eccentric strengthening: resistance band and cable training, dumbbell exercises (light, from 0.5-1 kg)
Proprioception & stability: ball and instability exercises (e.g. a wobble cushion, Airex pad)
Introducing weight-bearing on the arm slowly: four-point kneeling, modified push-ups against a wall

Phase 4: functional return (3-4 months)

Aims

Full shoulder function for everyday life
Building up sport-specific strength and movement

Measures

Increasing external rotation step by step to the individual normal value
Intensifying strengthening: dumbbells, cable machines, functional training, eccentric work for the rotators
Dexterity and plyometrics: medicine ball (light), reaction and stability exercises
Light jogging possible
No overhead or contact sports

Phase 5: return to sport (4-6+ months)

Aims

Regaining full sporting performance
A stable shoulder under sporting load

Measures

Sport-specific programmes: throwing progression (for throwing athletes), striking progression (tennis, volleyball)
Building up maximum strength step by step
Plyometric exercises (e.g. chest pass, overhead throws with a medicine ball)
Contact and martial arts usually from month 6-7 at the earliest