Arthroscopic Bankart Repair

An arthroscopic Bankart repair (ABR) is a keyhole operation to improve stability at the front of the shoulder in people who have a Bankart lesion.

A Bankart lesion is a tear or detachment of the labrum, the ring of cartilage around the rim of the shoulder socket. It usually happens when the shoulder dislocates forwards. Once the labrum has detached, the socket loses some of its depth and the shoulder can become prone to dislocating again.

The procedure

Small bone anchors are placed into the glenoid (the shoulder socket). Sutures attached to those anchors are used to reattach the labrum to the rim of the socket, and the joint capsule is sutured to them as well so that the capsule is tightened.

The anchors used are either all-suture anchors or bio-composite (ceramic) anchors, which are gradually replaced by the body’s own bone over time.

A Bankart repair can be done arthroscopically or through an open incision. Dr Cutbush performs the repair arthroscopically and books two hours of theatre time for the operation.

Risks and complications

General surgical risks

• Bruising and haematoma. The amount of bruising varies from person to person. It is a normal part of healing and usually settles quickly.
• Infection. Uncommon, and usually treated with antibiotics.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE). Blood clots in the leg or the lung. These can be serious if untreated, but the risk of harm is significantly reduced when they are treated promptly.
• Anaesthetic risk. This is discussed in detail with your anaesthetist before surgery. The risk of death under a general anaesthetic in Australia is approximately 1 in 100,000.
• Wound problems. Superficial wound problems can occur. Most need only a small intervention.

Risks specific to this procedure

• Shoulder stiffness. Uncommon, occurring in approximately 2% of patients. It usually resolves within the first 12 months. If it does not, an arthroscopic release can be done to restore motion.
• Frozen shoulder. Occurs in approximately 3% of patients. It resolves with time and can help the repair settle, but if it is severe, rehabilitation can be prolonged and difficult.
• Hardware problems. The sutures can sometimes cause problems that require a return to theatre to remove them.
• Recurrent instability. 5% or more of patients over long-term follow-up.

Before surgery

There are a number of things to organise while you are waiting for surgery. You will also be given detailed written instructions.

1. Confirm with your health fund that the hospital fee is covered by your policy.
2. Confirm the anaesthetist’s fees.
3. Register your details with the hospital.
4. Read, complete and return the paperwork to Dr Cutbush’s office.
5. Plan your transport to and from hospital. You will not be able to drive yourself home.
6. Arrange any pre-operative physiotherapy that has been recommended.
7. Arrange any pre-operative pathology that is required, such as blood tests.
8. Benzoyl peroxide 5% wash. Five applications to the shoulder in total, to reduce the risk of Cutibacterium acnes infection. Apply it twice daily for two days, then once more on the morning of surgery.
9. Hospital bag. Pack your regular medications in their original packaging, a loose button-up shirt, nightwear and toiletries. If you have sleep apnoea, bring your CPAP machine.
10. Blood thinners. Phone Dr Cutbush’s office to confirm when to stop them.
11. Diabetic tablets. Phone your anaesthetist to confirm whether to stop them before surgery.
12. Confirm your admission details with the office one to two business days before surgery.

The day of surgery

• Your admission details are confirmed one to two business days before surgery. Make a note of your admission time and your fasting time.
• Admission can be as early as 6am. If you live outside Brisbane, it is usually recommended that you stay in Brisbane the night before.
• After admissions you wait in the surgical waiting area. The anaesthetist consults with you before you have your general anaesthetic.
• Dr Cutbush greets you in the anaesthetic bay and marks the operation site with you.
• The hospital stay is usually one night, with discharge around 10am. Dr Cutbush reviews you before you are discharged.
• You are given a post-operative folder containing a letter describing what was found and what was done during surgery, along with rehabilitation and post-operative care information.
• Arrange for someone to take you home.

Recovery and healing

Recovery after an arthroscopic Bankart repair is generally straightforward, and physiotherapy begins immediately after surgery.

• A sling is required for up to six weeks. You will not be able to drive during this period.
• Your post-operative review with Dr Cutbush is usually at six weeks.
• Most people take around six weeks to recover, although symptoms can persist for up to twelve weeks.
• Adequate rest during this period is essential.

Rehabilitation

The goal of rehabilitation is to restore stability and function to the shoulder while the repair heals.

• The first four to six weeks. The shoulder is immobilised in a sling so that the cartilage repair can heal. If a posterior labral repair has been done, an external rotation (ER) brace is normally used instead of a sling. The brace is fitted either before surgery or the day after, on the ward.
• Gentle passive physiotherapy begins early to limit stiffness.
• From six weeks. The focus shifts to range of motion and strength.
• Around six to nine months. Normal activities, including high-intensity exercise and sport, can usually be resumed.

Day one

The hospital physiotherapist demonstrates how to fit the sling and how to eat, shower and dress while wearing it. Go through these with the physiotherapist before you leave hospital.

Goals

• Protect the healing repair by avoiding combined external rotation, abduction and extension.
• Help manage pain and inflammation.
• Keep passive glenohumeral range limited, to avoid excessive stiffness, while keeping the adjacent joints moving actively.
• By week six: flexion to 90 degrees and external rotation of 0 to 10 degrees.
• Maintain range of motion in the adjacent joints and good scapular posture.

Sling

• Worn full time for six weeks, except when showering and doing your exercises.
• Come out of the sling two to three times daily, for your prescribed exercises only.

Precautions

• No active use of the glenohumeral joint.
• Avoid abduction combined with external rotation, and avoid elevation movements.

Exercises

• The sling is fitted correctly and you learn to put it on and take it off independently, with the hand aligned to the midline of the body.
• Ice is used appropriately.
• Light hand use only, within the sling.
• Passive pendulum exercises to 80 degrees of flexion, and stick-assisted external rotation in neutral to 0 to 10 degrees.
• Active movement of the adjacent joints.
• Scapular awareness, with recruitment of the upper and mid trapezius.

Follow-up

• Your local physiotherapist at two weeks, to check pain, your home exercises and your precautions.
• Formal physiotherapy starts after the week six visit with Dr Cutbush and the shoulder physiotherapist.

Results after surgery

Published series report good long-term results after arthroscopic Bankart repair, with a low rate of recurrent instability, and many patients return to their pre-injury activity level. Individual results vary, and depend on factors such as your age, the number of previous dislocations, the amount of bone loss and the demands of your sport or work.

Rehabilitation is slow and often takes at least six to nine months. Some aching after surgery is common and can last for a while.

Next steps

• Anterior shoulder instability
• Shoulder instability
• Shoulder anatomy
• Surgery FAQs
• Book a consultation

This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.