Bankart Lesion Thomas J Kovack DO. Bankart Lesion

Bankart Bankart LesionLesion

Thomas J Kovack DOThomas J Kovack DO

Bankart Bankart LesionLesion

Normal AnatomyNormal Anatomy Shoulder is a ball and socket type jointShoulder is a ball and socket type joint

Joint is surrounded by many ligaments Joint is surrounded by many ligaments and muscles to support the jointand muscles to support the joint

The labrum is a structure that attaches The labrum is a structure that attaches to the socket to help increase stability to the socket to help increase stability of the jointof the joint

Normal AnatomyNormal Anatomy

InjuryInjury

With trauma to the shoulder the joint may With trauma to the shoulder the joint may dislocatedislocate

Most commonly dislocated joint in the Most commonly dislocated joint in the bodybody

Most common direction of dislocation is Most common direction of dislocation is anterior anterior

Bankart LesionBankart Lesion

As the humerus dislocates the As the humerus dislocates the labrum may be tornlabrum may be torn

This is referred to as a Bankart This is referred to as a Bankart LesionLesion

Named for the English surgeon who Named for the English surgeon who originally described itoriginally described it





Occasionally a bony piece of the Occasionally a bony piece of the socket will fracture off with the socket will fracture off with the labrum; called a “bony Bankart” labrum; called a “bony Bankart” lesionlesion

Hill-Sachs lesionHill-Sachs lesion

After anterior dislocation can also After anterior dislocation can also have damage to the humeral head as have damage to the humeral head as glenoid drives into itglenoid drives into it

This is called a Hill-Sachs lesionThis is called a Hill-Sachs lesion

Bankart LesionBankart Lesion These lesions can make shoulder unstable These lesions can make shoulder unstable

and lead to recurrent instability and repeat and lead to recurrent instability and repeat dislocationsdislocations

Incidence of repeat dislocations is related Incidence of repeat dislocations is related to ageto age-patient < 20 yrs old 80-90%-patient < 20 yrs old 80-90%

-patients 20-30 yrs old 50-75%-patients 20-30 yrs old 50-75% -patients >40 yrs old lower rates of repeat -patients >40 yrs old lower rates of repeat

dislocations, higher rate of rotator cuff teardislocations, higher rate of rotator cuff tear

TreatmentTreatment

Can try non-operative treatment Can try non-operative treatment initiallyinitially

-Immobilization in external rotation -Immobilization in external rotation brace can allow labrum to brace can allow labrum to potentially heal in its normal potentially heal in its normal positionposition

TreatmentTreatment

Must wear brace for 3 weeks Must wear brace for 3 weeks continuouslycontinuously

After 3 weeks in the brace will begin After 3 weeks in the brace will begin physical thearpy to regain ROM and physical thearpy to regain ROM and strenghten shoulderstrenghten shoulder

Recurrence of InstabilityRecurrence of Instability

Despite non-operative treatment may have Despite non-operative treatment may have a recurrence of instabilitya recurrence of instability

Can lead to multiple dislocations and wear Can lead to multiple dislocations and wear of the anterior glenoidof the anterior glenoid

Recurrent dislocations can effect quality of Recurrent dislocations can effect quality of lifelife

-lead to apprehension and pain-lead to apprehension and pain

-inability to work-inability to work

-inability to participate in hobbies or sports-inability to participate in hobbies or sports

Operative TreatmentOperative Treatment

If having recurrent instability surgery If having recurrent instability surgery is indicatedis indicated

Benefits of surgery:Benefits of surgery:

-allows for stabilization of shoulder -allows for stabilization of shoulder and reduce chance of dislocationsand reduce chance of dislocations

-less apprehension and more -less apprehension and more confidence in range of motionconfidence in range of motion

-can improve quality of life and return -can improve quality of life and return to normal activitiesto normal activities


Surgery is done arthroscopicallySurgery is done arthroscopically

-small incisions with limited morbidity-small incisions with limited morbidity

-labrum is repaired using anchors and -labrum is repaired using anchors and suturessutures

-same day surgery-same day surgery


Operative RepairOperative Repair

Post-opPost-op

After surgery you are placed in After surgery you are placed in external rotation brace for 3 weeksexternal rotation brace for 3 weeks

Come out of brace only to work on Come out of brace only to work on pendulum exercisespendulum exercises

Post-opPost-op

At 3 weeks begin working on active At 3 weeks begin working on active assisted range of motion with physical assisted range of motion with physical therapytherapy

10 weeks post op can begin gentle 10 weeks post op can begin gentle liftinglifting

At 6 months can return to activity as At 6 months can return to activity as toleratedtolerated

Results of SurgeryResults of Surgery

Most patients do well after surgeryMost patients do well after surgery

Satisfactory outcomes occur in greater Satisfactory outcomes occur in greater then 90% of patients in most studiesthen 90% of patients in most studies

Majority of patients are able to return to Majority of patients are able to return to pre-injury activitiespre-injury activities

Results of SurgeryResults of Surgery

Rate of recurrence after surgery Rate of recurrence after surgery estimated between 5%-15% estimated between 5%-15%

Recurrence is higher in:Recurrence is higher in:

-patients with bony bankart-patients with bony bankart

-patients with large Hill-Sachs lesion-patients with large Hill-Sachs lesion

-patients with generalized laxity-patients with generalized laxity((Boileau)Boileau)

ComplicationsComplications Loss of motion-most commonly external rotationLoss of motion-most commonly external rotation InfectionInfection Nerve injuryNerve injury Cartilege injuryCartilege injury ArthritisArthritis Arterial InjuryArterial Injury Risks of AnesthesiaRisks of Anesthesia

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Bankart Lesion Thomas J Kovack DO. Bankart Lesion