AANA Lab Course 904 - Shoulder Superstars: Everything You Can Do in a Shoulder Through the Scope! (APEx)-Case Presentation_ Arthroscopic Bankart Repair; My Tips and Tricks

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This presentation by Dr. Richard K.N. Ryu reviews arthroscopic Bankart repair for recurrent anterior shoulder instability, focusing on improving outcomes of an already established surgical procedure.<br /><br />Indications for arthroscopic Bankart repair primarily include symptomatic recurrent anterior shoulder instability and high-risk first-time anterior dislocations. However, recurrence rates after arthroscopic Bankart repair range widely (18-35%), demonstrating room for better outcomes. Moreover, failure should not be defined solely by recurrence; “sub-critical” glenoid bone loss (~13.5%) can also cause significant functional impairment without frank recurrence.<br /><br />Several risk factors for failed arthroscopic Bankart repair are identified: young age, bone loss on glenoid or humerus, ligamentous laxity, contact sports, male sex, time from injury to surgery, number of dislocations, and technical factors such as number and placement of suture anchors and immobilization duration. Notably, contact athletes with significant bone loss (“inverted pear” glenoid or engaging Hill-Sachs lesion) have recurrence rates as high as 89%.<br /><br />Advanced surgical techniques are recommended to optimize outcomes, including: patient selection emphasizing risk mitigation; performing surgery in lateral decubitus position; always placing an inferior 6 o’clock anchor to address inferior capsule; early incorporation of bone grafting or addressing bony Bankart fragments; routine assessment of glenoid track to identify “off-track” lesions requiring bony procedures or remplissage; and use of remplissage especially for significant Hill-Sachs defects. Remplissage lowers recurrence with minimal motion loss except in throwing athletes, where return to sport rates are moderate.<br /><br />Arthroscopic autogenous bone grafting (e.g., distal clavicle or iliac crest) is emerging as a desirable alternative to open Latarjet, which has higher complications and alters anatomy more. Rehabilitation should be slower with longer immobilization (4-6 weeks minimum) and staged range of motion.<br /><br />In summary, mitigating intrinsic risk factors through careful patient selection, combined with modern technical refinements—including lateral positioning, comprehensive anchor placement, remplissage, incorporation of bone grafts, and conservative rehab—can improve arthroscopic Bankart repair success rates beyond current standards.

Asset Caption

Dr. Richard K.N. Ryu, M.D.

Keywords

arthroscopic Bankart repair

anterior shoulder instability

recurrent dislocations

glenoid bone loss

Hill-Sachs lesion

remplissage technique

bone grafting

lateral decubitus position

suture anchor placement

rehabilitation protocols