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