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The Classic Bankart Procedure
Indications, Technique, and Results
The Classic Bankart Procedure
Indications, Technique, and Results
James P. Bradley, M. D.Joel Gonzales, M. D.
Robert W. Metcalf, M. D. Memorial
SunValley, Idaho 1999
History
• Perthes
• Bankart
• Moseley and Overgaard 1962
• Rowe
History
• Over 150 procedures described for treatment of anterior shoulder instability
Bankart, A. S. B.
• Recurrent or habitual dislocation of the shoulder-joint
• British Med. J., 2:1132-1133, 1923.
Indications
• Anterior/Inferior Glenohumeral Instability
• Recurrent
• Post - Traumatic/ Involuntary
• History and Physical
• Positive apprehension and relocation
• Bankart lesion/ Hill Sachs
Indications
“Good exposure, adequate help, and proper instruments are essential.”
Carter Rowe
JBJS 1978
Approach
• Skin Incision - Coracoid to axilla
• Deltopectoral Approach
• Low axillary for cosmesis
Approach
• Coracoid osteotomy not necessary
Subscapularis
• External rotation exposes subscapularis
• Circumflex vessels at inferior border
• Axillary nerve!
Subscapularis
• Careful dissection to avoid buttonholing capsule!
• Begin distally and use stay sutures
• OK to leave some subscap on capsule
Capsular Incision
• Arm completely externally rotated
• Incise capsule just lateral to glenoid rim
• Insert humeral head retractor and assess labrum
Glenoid Preparation
• Freshen bone with burr
• 3 holes in glenoid rim with awl (suture anchors today)
Repair
• Lateral capsule flap sutured to rim
• Medial flap imbricated over lateral flap
Repair
• Anatomic repair of subscapularis
Carter Rowe et al.
• The Bankart Procedure. A long-term end result study
• JBJS 60A: 1-16, Jan 1978.
Materials and Methods
• 145 cases 1946-1976, 124 re-examined, 21 by questionnaire
• Average 6 year follow up
• Rowe rating scale – Stability 50 points, ROM 20 points, Function
30 points
Results
• 74% Excellent (90-100 points)
• 23% Good (75-89 points)
• 3% Poor
• 5 Recurrences
Results
• 86/124 regained full elevation and external rotation
• No evidence of degenerative changes (124/124)
• No formal post op therapy
Hovelius
• Recurrent Anterior Dislocation of the Shoulder
• Results after the Bankart and Putti-Platt Operations
• JBJS 61A, June 1979
Hovelius
• 46 Bankarts, 9 different surgeons
• Short follow up
• 1 recurrence, 16 degree loss of external rotation
• 42/46 “satisfied” with procedure
Gill, Micheli et al.
• Bankart Repair for Anterior Instability of the Shoulder
• JBJS 79A, June 1997
Materials and Methods
• 60 Shoulders (56 patients 39m 17f)
• One surgeon
• 21.4 years average
• Follow up 11.9 years (range 8-16 years)
• ASES rating
Results
• 52/56 good to excellent
Complications
• 12 degrees mean loss of external rotation
• 3 Redislocations
Complications
• Not truly an ANATOMIC repair!
• Loss of ER - overtightening (Critical for overhead athletes)
• Arthrosis
Complications
• Technically difficult
• Violates glenoid cartilage
Classic Bankart Procedure
• Many still consider this the gold standard
Alternatives
• ACLR
• Jobe
• Matsen
• Neer
• Rockwood
• Thermal Shift ?
Older Procedures
• Hot Poker
• Nicola
• Magnuson-Stack
• Putti-Platt
• Bristow-Helfet
Older Procedures
• DuToit (staple)
• Eden-Hybinette
• Oudard
• Trillat
• Latarjet
• Gallie
• Saha
• Boytchev
Thank you