Hawkins – Bankart 1

Modern Study Review (AI-Generated)

High-Yield Summary

The Hawkins-Bankart 1 procedure is a classic open surgical technique for anterior shoulder instability due to Bankart lesions. It remains relevant in cases where arthroscopic repair is contraindicated or has failed. Understanding the detailed anatomy and surgical approach is critical for safe and effective repair, minimizing neurovascular injury, and restoring shoulder stability and function.

Key Diagnostic Findings

Anatomy

• Bankart Lesion: Detachment of the anteroinferior labrum from the glenoid rim, often with capsular injury.
• Relevant Structures:
• Subscapularis tendon (key for surgical approach)
• Conjoint tendon (medial to the approach)
• Axillary nerve (inferior to the capsule)
• Thoracoacromial artery (deltopectoral interval)
• Anterior circumflex humeral artery (inferior border of subscapularis)

Clinical Presentation

• Recurrent anterior shoulder dislocations or subluxations
• Anterior shoulder pain and instability, especially with abduction and external rotation
• Positive apprehension and relocation tests

Imaging

• MRI/MRA: Confirms Bankart lesion, capsulolabral detachment, and associated Hill-Sachs lesions
• CT Scan: Useful for assessing glenoid bone loss and planning surgery

Classification Systems

• Bankart Lesion: Classified by extent and involvement of labrum and capsule
• Glenoid Bone Loss: Quantified to guide surgical decision-making (e.g., >20-25% bone loss may require bony augmentation)

Current Gold Standard Treatment

Non-operative

• Indicated for first-time dislocators without significant bone loss or high-risk activities
• Physical therapy focusing on rotator cuff and scapular stabilizers
• Activity modification

Operative Indications

• Recurrent dislocations despite conservative management
• Significant capsulolabral injury (Bankart lesion)
• Glenoid bone loss <20-25% (Bankart repair alone)
• Failed prior non-operative or arthroscopic treatment

Operative Treatment

• Arthroscopic Bankart Repair: Preferred modern approach with suture anchors to reattach labrum and capsule
• Open Bankart Repair (Hawkins Technique): Reserved for complex cases or revision surgery
• Deltopectoral approach with careful dissection of subscapularis tendon
• Capsular mobilization and reattachment to glenoid rim with suture anchors or transosseous sutures
• Glenoid rim preparation with osteotome for healing surface

Modern Complications & Outcomes

Complications

Outcomes

• Arthroscopic Bankart repair shows >85% success in restoring stability and function
• Open Bankart repair remains effective, especially in revision or complex cases
• Long-term outcomes depend on patient selection, bone loss, and rehabilitation adherence
• Focus on pain relief and return to pre-injury activity level

Classic Clinical Notes

Hawkins-Bankart1 Surgical Technique

Bankart Repair – Dr. Hawkins

Positioning:

• Supine, 45° beach chair with head in Mayo headrest
• Legs tipped up 20°, back tipped up 25° to total 45°
• Arm resting on armrest, head centered

Prepping and Draping:

• Shave area
• 10×10 steri-drape across neck
• Mark acromion and AC joint
• Incision: transverse, in line with fibers, ~1 cm medial to lateral border of acromion, 10-12 cm long

Approach:

• Anterior deltopectoral approach
• Skin incision vertical from axillary fold upwards, then down 2 cm along axillary fold with arm abducted
• Blade through skin, cautery through epidermis to fat
• Identify and de-roof cephalic vein
• Blunt dissection between deltoid and pectoralis muscles
• Mobilize thoracoacromial artery branch superiorly
• Identify conjoint tendon and coracoid process
• Insert coracoid retractor
• Identify lateral border of conjoint muscle/tendon complex
• Avoid denervating lateral muscle by careful dissection medial to tendon
• Mobilize conjoint complex medially to identify subscapularis tendon

Subscapularis Incision:

• Vertical incision ~1.5 cm medial to insertion
• Cauterize carefully to avoid anterior circumflex humeral vessel inferiorly
• Sometimes “hockey-stick” incision medially
• Dissect through subscap tendon fibers to reach capsule
• Use blunt dissection inferiorly, extend superiorly preserving tendinous cuff for repair
• Cobb and 15 blade to develop plane between tendon and capsule
• Tag superior border of medial subscap tendon flap

Capsular Incision:

• Vertical incision 7-10 mm medial to subscap incision
• Inferiorly, cut upwards away from axillary nerve
• Superiorly, preserve capsule for later suture
• Insert Fukuda humeral head retractor to expose glenoid
• Identify Bankart lesion anteriorly
• Undermine capsule off anterior glenoid, dissect adherent capsule and labrum off glenoid neck
• Use Cobb to peel capsule off bony glenoid neck
• Insert forked retractor to retract capsule and expose anterior glenoid
• Roughen glenoid with osteotome and mallet
• Identify suture holes, start with single tap from articular surface, connect with tap on bony side
• Use clamp device for suture hole preparation

If you need further details on the surgical steps or modern arthroscopic techniques, please let me know.

Last Updated on January 25, 2026 by orthonet