Bankart lesion

Anatomy: labrum, capsule and shoulder stability

The shoulder joint consists of the spherical head of the upper arm (humerus) and the comparatively flat socket of the shoulder blade (glenoid). Stability is created through an interaction between passive structures (labrum, joint capsule, ligaments) and active stabilizers (rotator cuff, shoulder blade muscles).

• Labrum: fibrocartilage ring, enlarges the socket surface and serves as an attachment for the joint capsule.
• Joint capsule and ligaments: The anteroinferior capsule-ligament complex (IGHL) in particular limits the forward tilting of the humeral head.
• Dynamic stability: The rotator cuff and scapula muscles position the humeral head centered (“scapula control”).

In a Bankart lesion, the anteroinferior labral capsule complex is affected. This can weaken the “front barrier” of the shoulder and lead to instability in the abduction and external rotation positions.

What is a Bankart Lesion?

A Bankart lesion is the tearing of the anterior lower labrum, including the capsular attachment from the glenoid socket. It usually occurs after an anterior shoulder dislocation or a pronounced subluxation.

• Soft Tissue Bankart: Torn labrum/capsule without bone involvement.
• Bony Bankart: In addition, a bone fragment has broken off from the anterior glenoid.
• Variants: Perthes, ALPSA or GLAD lesion (differences in displacement/healing and cartilage involvement).

Distinction: A SLAP lesion affects the superior socket rim and the biceps tendon anchor, while the Bankart lesion is anterior-inferior. A common accompanying injury is the Hill-Sachs dent on the head of the humerus, which can “lock in” with repeated dislocations.

Causes, mechanism and risk factors

A typical trigger is a fall or force on the outstretched arm in abduction and external rotation, causing the head of the humerus to jump forward out of the socket. This causes the labrum-capsule complex to tear away from the glenoid.

• Younger age and contact sports (e.g. handball, rugby, martial arts).
• General ligament laxity or congenital hypermobility.
• Previous dislocations/subluxations (recurrent instability).
• Bony defects: loss of glenoid rim (bony Bankart) or pronounced Hill-Sachs dent.
• Capsular overstretching after repeated microtraumas.

Younger, physically active patients have an increased risk of recurring instability events. This is taken into account individually when deciding on therapy.

Symptoms and warning signs

• Feeling of insecurity or buckling of the shoulder during abduction/external rotation (apprehension).
• Pain in the front shoulder, often dependent on stress.
• Snapping, rubbing or “subluxation” feeling with certain movements.
• Reduced strength, especially during overhead sports.
• After acute dislocation: swelling, restricted movement.

Warning signs after dislocation: Numbness, tingling, feeling of cold in the arm/hand, no pulse or persistent misalignment should be checked by a doctor promptly.

Diagnostics: clinical and imaging

Diagnosis is based on history (mechanism of accident, episodes of instability), clinical tests and imaging. The assessment of accompanying injuries and bony defects is also crucial.

• Clinical tests: apprehension and relocation test (anterior instability), load and shift, assessment of general laxity; Strength and function testing of the rotator cuff.
• X-ray: exclusion of fractures, assessment of the glenoid rim and the humeral head contour (axial/axillary image).
• MRI, if necessary MR arthrography: visualization of the labrum, capsule, rotator cuff and cartilage.
• CT (3D) for suspected bony defect: quantification of glenoid edge loss and assessment of Hill-Sachs geometry.

What is important for therapy planning is whether the Hill-Sachs dent “engages” and how large the glenoid edge loss is. These parameters influence whether soft tissue reconstruction is sufficient or whether bony procedures are considered.

Differential diagnoses and accompanying injuries

• SLAP lesion (superior acetabular rim, biceps anchor).
• Hill-Sachs lesion (indentation defect in the humeral head) – a common accompanying injury.
• Glenoid cartilage damage (GLAD) and chondrolabral junction.
• Rotator cuff lesions or biceps tendon disorders.
• Fracture of the greater tuberosity or glenoid rim fracture.
• AC joint involvement, capsule overstretching or irritated joint lining (synovitis).

The exact distinction is relevant because therapeutic measures vary. If there is simultaneous cartilage or bony damage, the procedure can be adjusted.

Conservative therapy: first stabilize in a structured manner

Conservative treatment is the first step - especially in the case of a first-time event, low instability and no relevant bony defects. The aim is to reduce pain, center the shoulder and improve muscles and coordination.

• Acute phase: Short-term immobilization in a sling, cooling, inflammation management, pain-adapted mobilization.
• Early function: Physiotherapy with a focus on shoulder blade control (scapular setting) and pain-free regain of mobility.
• Stabilization: Strengthening the rotator cuff (internal/external rotators), posterior shoulder chain, core and proprioception training.
• Sports modification: Avoiding risky positions (max. abduction/external rotation) until stable control.
• Aids: taping/shoulder orthoses in transition phases – consider individually.

The training builds up gradually over weeks. Success and time requirements vary depending on the extent of instability, sport and individual factors. If there are repeated dislocations or a persistent feeling of insecurity, the indication for surgery should be examined.

Surgical therapy: indications and procedures

Surgery is considered in cases of recurrent anterior instability, functionally relevant apprehension despite adequate physiotherapy, high sporting demands or proven bony defects. The choice of procedure depends on soft tissue damage, bone loss and sports profile.

• Arthroscopic Bankart refixation: reattachment of the labrum to the glenoid using anchors, often combined with capsular tightening (plication).
• Remplissage: Additional “filling” of a latching Hill-Sachs dent through tendon/capsular augmentation to prevent latching.
• Bony procedures (e.g. Latarjet): If there is a relevant glenoid edge deficiency, the anterior edge of the socket is enlarged and stabilized with bone transfer.

The procedures are usually minimally invasive (arthroscopic); Bony reconstructions can be performed open or arthroscopically. Risks include, among others: Bleeding, infection, stiffness, nerve irritation, persistent instability or pain. The information is provided individually and comprehensively.

Follow-up treatment, rehabilitation and return to sport

Rehabilitation is crucial to the outcome. It is based on pain, healing process and the procedure carried out. Typically, the shoulder is gradually loaded and control of the scapula and rotator cuff muscles is developed.

• Physiotherapy with clear target corridors (movement – ​​control – strength – sport specifics).
• Criteria-based increases instead of rigid timelines.
• Prevention: Continuously work on scapular and rotator cuff stability.

Return times are guidelines and depend on the individual course, the sport and intraoperative findings.

Prevention and everyday tips

• Regular stabilization and coordination training for the shoulders and torso.
• Pay attention to shoulder blade control when working overhead and during training.
• Technical training in contact and throwing sports; avoid risky end positions.
• Adequate regeneration and gradual increase in load after injuries.
• If you are unsure or have recurring feelings of subluxation, see an orthopedic doctor at an early stage.

Your treatment in Hamburg

In our practice at Dorotheenstrasse 48, 22301 Hamburg, we clarify Bankart lesions using modern clinical examination and targeted imaging. We follow a conservative approach with structured physiotherapy and individual training planning. Surgical options are only discussed if there are clear indications and after detailed information - if desired, in cooperation with experienced shoulder surgeons. Doctolib and email are available for making appointments.