Dr. Shetty's Center of Orthopaedics

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Bankarts/Labral Repair

sports injury treatment - Bankarts repair in HSR layout

Ball-and-Socket Configuration:

Ball-and-socket configuration of the shoulder joint plays a pivotal role in providing stability and high freedom of mobility. In a healthy shoulder joint, the ball and socket remain in stable positions, with the ball (humeral head) centred in the shallow socket (glenoid or glenoid cavity). The glenoid labrum, a fibrocartilaginous rim that encircles the glenoid’s edge, reinforces the stability of this joint by making its concavity deeper. This Glenoid labrum can be compared to a water dam wall (bumper), which prevents the humeral head from dislocating. Multiple ligaments (SGHL, MGHL, and anterior and posterior bands of IGHL) also help hold the humeral head inside its socket by providing good stability.
sports injury treatment - Bankarts repair in HSR layout

A sudden shoulder injury during a sporting activity or road traffic accident can create a forceful dislocation. This event of dislocation rips and tears apart the bumper (labrum) from the front and inferior aspects of the Glenoid bone socket, which is called Bankart’s lesion. When the labrum is torn, the bony cartilage rim around the socket is compromised (the water dam’s wall is broken off), allowing the humeral head to slip forward and dislocate with exertional movements.

Most Bankart lesions are caused by anterior dislocations-

when the arm moves too far forward and down (the head of the arm bone moving out of its place in a forward direction). Few dislocations occur in the reverse direction, with the arm moving backwards out of the glenoid bone socket, causing damage to the back portion of the labrum tissue.

If this injury is associated with a fracture of the shoulder socket (glenoid cavity), this is called a bony or osseous Bankart lesion.

An untreated Bankart lesion can lead to chronic shoulder instability, meaning your shoulder may dislocate again in the future, probably in situations involving less force than the original injury.

Causes-

  • Road Traffic Accidents: A sudden blow to the shoulder can knock the ball (head of humerus arm bone) from its socket (Glenoid bone), tearing the labrum.
  • Sports Injuries: Crashing into another person with speed and force — for example, during a football or hockey tackle — can shove the shoulder out of alignment or drag the arm forward or backward, leading to dislocations.
  • Direct fall on the shoulder (sports): Falling and landing on one’s shoulder can lead to shoulder dislocations in athletes, especially in sports where falling with height or speed is common, like gymnastics, skating, rollerblading, or skiing.
  • Falls (not from sports): Falling off a building or from a certain height can deliver enough force to dislocate the shoulder. Older adults and those with gait problems can be highly prone to this kind of fall.
  • Overuse injuries: In some athletes, overuse of the shoulder can lead to loose ligaments and instability. Swimmers, tennis players, volleyball players, baseball pitchers, gymnasts, and weight lifters are prone to this problem. Also, non-athletes may develop instability from repeated overhead motions of the arm (for example, swinging a hammer).
  • Lax Ligaments: Some people have very lax ligaments, leading to dislocation of the shoulder easily with minimal exertion.
Symptoms- Apprehension and Feeling of Giving Away: Patients with Bankart’s tear and a history of repeated dislocations try to avoid certain movements at the level of the shoulder. When they are forced to make such movements, they get a feeling of instability. Pain while doing overhead activities like combing or taking off some objects from a high shelf

Treatment for Bankarts repair:

Non-operative:

This conservative management is offered to older patients and those who are less active or have a sedentary lifestyle. Once the dislocation is reduced, the patient is asked to wear an arm pouch sling where the patient’s arm is placed across the chest in internal rotation for 2 weeks. After that, physiotherapy is started to increase mobility and gain strength.

Operative:

Bankart repair surgery tends to be the treatment of choice for younger patients with a Bankart lesion, especially those who play sports, as there is a high risk of the shoulder dislocating again. This is because the glenoid labrum tear often fails to heal properly, so it doesn’t provide the extra depth to the socket that is needed, reducing its stability and increasing the risk of further dislocation.

Procedure & Post-Surgery Care Details:

Dr. Akshay Shetty, one of the best sports injury doctors, performs Bankart’s repair is done arthroscopically (keyhole surgery) under general anaesthesia. This surgery aims to repair the avulsed labrum and tighten overstretched and misplaced ligaments and capsules. Suture anchors are placed in the bone, and the torn glenoid labrum is reattached to the glenoid socket. You can usually go home the same day or the following day after a Bankart repair. An arm pouch sling is mandatory to be worn throughout the day and even while sleeping for 4-6 weeks to protect the repaired tissue. Physiotherapy will be started immediately after surgery. You will take 4-6 months to complete your recovery and get back to sports. For specialized care in sports injury treatment and Bankart’s repair in HSR Layout, BTM, and Koramangala, consult with Dr. Akshay Shetty, an experienced orthopedic specialist & best sports injury doctor in Bangalore.