The shoulder joint is represented by the humeral head (spherical), which articulates with the glenoid cavity (it looks like a flat plate), which has on its edge a structure (like a gasket) called labrum, which participates in stabilizing the humeral head in the joint.

What is a Bankart lesion?

When the labrum in the shoulder joint is torn, the stability of the joint is compromised. A certain type of labral injury is called a Bankart lesion. A Bankart’s lesion occurs when a person suffers a shoulder dislocation. This usually occurs in young patients. (Detachment of the anteroinferior labrum from the glenoid with involvement of the inferior glenohumeral ligament). The continuity between the cartilage and the labrum is broken, but the periosteum remains intact. In acute dislocation, interstitial hemorrhage is present, whereas recurrent dislocations leave a fringing of tissue. It is very important to inspect this lesion because it is often associated with other changes (fractures, periosteal detachments) that cannot be resolved arthroscopically.

What is the treatment for a Bankart lesion?

There are two general options for the treatment of Bankart injuries. The first option is to rest the shoulder by immobilizing the arm in a sling. This is usually followed by physiotherapy to regain mobility in the shoulder joint, but usually, due to detachment of the labrum from the glenoid, the humeral head can come out of the joint at any time, resulting in a humeral head luxation.
The other option is to perform surgery to repair the torn labrum (reattach the labrum to the glenoid with a suture, thus closing the space through which the humeral head dislocates). The results of surgery are usually very good, with over 90% of patients returning to daily activities without further shoulder dislocations. This operation is usually performed arthroscopically.
What are the chances of a repeat dislocation after a Bankart injury?
The chance of shoulder dislocation after a Bankart injury depends on the age of the patients. Young people are most prone to Bankart injuries, and are therefore more likely to repeat it. Statistically, the odds of shoulder redislocation are 80% higher in patients younger than 30. Over the age of 30, the odds of repeat dislocation decrease significantly.

Is surgery recommended after an initial shoulder dislocation?

Some orthopaedists recommend surgery to repair a Bankart injury after a shoulder sprain in young athletes. The usual treatment consists of a period of immobilization of the shoulder, followed by intensive physiotherapy. Then a gradual return to everyday activities. If the shoulder is dislocated again, surgery is mandatory.
However, some orthopaedists will repair a Bankart’s injury after a first shoulder dislocation in young athletes, as the chance of a recurrence of a shoulder dislocation is high, especially in contact sports athletes. A Bankart’s lesion takes at least six months to heal and many patients want to return to everyday activities as soon as possible without fear of a possible recurrence, so surgery is often the optimal solution.

What is the best solution?

There is no “right” answer to this question. It is true that young athletes, especially those who participate in contact sports (e.g. soccer), frequently dislocate their shoulder and have a very high chance of having it re-dislocated without surgery.
It is important to remember that a Bankart repair is major surgery and recovery is not easy. Kinetotherapy can be tried, but the patient must understand that a shoulder realignment is very possible.
In making the right decision we must also take age into account. Patients over the age of 30 are less likely to be able to undergo a repositioning. Patients over the age of 30 generally do not need surgery, except for patients who have already suffered repeated shoulder dislocations.