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Shoulder instability is a common issue faced by athletes, active individuals, and even those with more sedentary lifestyles. You are more likely to see this in people aged 15 to 35. Those over 40 who dislocate their shoulders often have a rotator cuff tear as well. Recurrent shoulder dislocations can lead to chronic pain, dysfunction, significant decrease in quality of life and long-term damage to the shoulder joint. Bankart repair is a specialized surgical intervention aimed at addressing this condition by restoring stability and functionality to the shoulder joint.

Anatomy of Shoulder Instability

The shoulder joint is inherently the most mobile joint in the body, allowing a wide range of motion but sacrificing stability. It is a ball-and-socket joint where the humeral head (the ball) sits in the glenoid cavity (the socket). Stability is maintained by:

• Labrum: A fibrocartilaginous rim that deepens the glenoid cavity, increasing contact with the humeral head.
• Ligaments and Capsule: These connect the bones and maintain alignment. These structures reinforce the joint and provide stability during movement
• Rotator Cuff Muscles: A group of muscles and tendons that stabilize the humeral head within the glenoid socket.

In cases of shoulder dislocation, the labrum and associated ligaments can become torn, leading to persistent instability. The Bankart lesion, a specific type of labral tear, is commonly associated with anterior shoulder dislocations.

A similar injury can happen at the back of the joint, known as traumatic posterior shoulder instability, but it is much rarer. This type of instability often results from events like falling on an outstretched hand.

Another kind of instability is atraumatic instability, which occurs without any injury. In this case, the shoulder struggles to keep the ball properly positioned in the glenoid socket. Often, atraumatic instability can cause the shoulder to move in various directions, referred to as multidirectional instability. In this situation, there are usually no tears, but the shoulder’s stabilizing structures fail to function properly. People with loose joints are more likely to have atraumatic instability.

What Is Bankart Repair?

Bankart repair is a surgical procedure aimed at reattaching the torn labrum to the glenoid rim. By restoring the anatomy of the shoulder, it provides long-term stability and prevents recurrent dislocations.

Indications for Bankart Repair:

• Recurrent anterior shoulder dislocations.
• Diagnosis of a Bankart lesion confirmed by imaging techniques such as MRI or CT scans.
• Young, active individuals engaged in sports or activities requiring high shoulder stability.
• Failure of non-surgical interventions like physical therapy.

Surgical Techniques in Bankart Repair:

The procedure is predominantly performed arthroscopically, ensuring minimal invasiveness and faster recovery. Key steps include:

1. Preparation: The patient is positioned in lateral decubitus position to optimize surgical access.
2. Arthroscopic Access: Small incisions are made to insert an arthroscope and specialized surgical instruments.
3. Debridement: The surgeon removes damaged tissue and prepares the glenoid rim for repair.
4. Anchor Placement: Suture anchors are inserted into the glenoid bone to provide a secure base for the labral repair.
5. Labrum Reattachment: The torn labrum is reattached to the glenoid rim using sutures.

This technique restores the stabilizing function of the labrum while preserving the shoulder’s range of motion.

What Is Remplissage?

Remplissage (French for “to fill”) is an additional surgical technique performed in conjunction with Bankart repair to address Hill-Sachs lesions—compression fractures on the posterior aspect of the humeral head caused by repeated dislocations.

Indications:

• Hill-Sachs lesions that engage or “lock” the humeral head during shoulder movement.
• Combined with Bankart repair when instability persists despite addressing the labral tear.

Surgical Technique:

Remplissage is also performed arthroscopically and involves the following steps:

1. Visualization: The surgeon identifies the Hill-Sachs lesion.
2. Capsulotenodesis: The posterior capsule and infraspinatus tendon are anchored into the defect.
3. Closure: This fills the defect and prevents engagement during shoulder motion.

By “filling” the Hill-Sachs lesion, remplissage reduces the risk of recurrent dislocations and enhances shoulder stability.

Advantages

offers numerous benefits, making it a preferred choice for treating shoulder instability:

1. Restored Stability: By reattaching the labrum, the shoulder’s natural stabilizing mechanism is reinstated.
2. Minimally Invasive Procedure: Arthroscopic techniques result in smaller incisions, reduced scarring, and quicker recovery times.
3. Improved Range of Motion: Most patients regain full functionality and strength post-rehabilitation.
4. Lower Recurrence Rates: The procedure significantly reduces the risk of future dislocations, particularly in active individuals.

Postoperative Recovery and Rehabilitation

Successful outcomes from Bankart repair depend on adherence to a structured rehabilitation program. Recovery can be broadly divided into several phases:

Phase 1: Immediate Postoperative Period (0-6 weeks)

• Immobilization: The shoulder is immobilized in a sling to protect the repair.
• Pain Management: Medications are used to control pain and inflammation.
• Passive Range of Motion: Gentle exercises are introduced to maintain mobility without stressing the repair after suture removal.
• Isometric strengthening exercises initiated after suture removal.

Phase 2: Early Rehabilitation (6-12 weeks)

• Active Range of Motion: Gradual reintroduction of active shoulder movements begins.
• Muscle Activation: Focus on activating and strengthening the rotator cuff and surrounding muscles.

Phase 3: Strengthening Phase (3-6 months)

• Progressive Strengthening: Resistance exercises target the rotator cuff and scapular stabilizers.
• Functional Training: Activities that mimic daily tasks and sports-specific movements are incorporated.

Phase 4: Return to Activity (6+ months)

• Clearance for Sports: Patients may resume high-impact activities or sports after achieving full strength and stability.
• Maintenance Exercises: Ongoing conditioning helps preserve shoulder health and prevent future injuries.

Risks and Complications

While Bankart repair is generally a safe and effective procedure, potential complications include:

1. Recurrent Instability: Rarely, some patients may experience another dislocation.
2. Stiffness: Inadequate rehabilitation or aggressive surgical techniques may lead to restricted motion.
3. Infection: As with any surgical procedure, there is a small risk of infection.
4. Hardware-Related Issues: Suture anchors may occasionally cause irritation or require removal.
5. Injury to nerves and blood vessels

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