Hawkins – Bankart 2

Modern Study Review (AI-Generated)

High-Yield Summary

The Hawkins-Bankart 2 technique is a surgical method for repairing Bankart lesions, which are detachment injuries of the anteroinferior glenoid labrum commonly associated with anterior shoulder instability. This procedure focuses on restoring the labral bumper and capsular tension to re-establish glenohumeral stability. Precise suture placement and capsular management are critical to optimize outcomes and prevent recurrent instability.

Key Diagnostic Findings

Anatomy

• Glenoid Labrum: Fibrocartilaginous rim that deepens the glenoid fossa and provides shoulder stability.
• Capsule: The joint capsule contributes to stability by tensioning around the glenohumeral joint.
• Subscapularis: Lies anterior to the capsule and must be managed carefully during repair.

Clinical Presentation

• Recurrent anterior shoulder instability or dislocation.
• Positive apprehension and relocation tests.
• History of traumatic anterior shoulder dislocation.

Imaging

• MRI/MR Arthrogram: Gold standard for detecting Bankart lesions and associated capsulolabral injuries.
• CT Scan: Useful for assessing glenoid bone loss and Hill-Sachs lesions.

Classification Systems

• Bankart Lesion: Detachment of the anteroinferior labrum from the glenoid rim.
• Hawkins Classification: Historically described surgical techniques for Bankart repair; modern practice favors arthroscopic classification and repair techniques.
• Updated Systems: The Instability Severity Index Score (ISIS) and glenoid bone loss quantification guide treatment decisions.

Current Gold Standard Treatment

Non-operative

• Reserved for first-time dislocators without significant bone loss or instability symptoms.
• Physical therapy focusing on rotator cuff and scapular stabilizers.
• Activity modification.

Operative Indications

• Recurrent anterior instability.
• Significant labral detachment confirmed on imaging.
• Glenoid bone loss <20% (arthroscopic Bankart repair preferred).
• Failed non-operative management.

Operative Technique (Modern Bankart Repair)

• Arthroscopic repair with suture anchors placed approximately 3-4 mm into the glenoid articular surface.
• Three or more sutures passed through the capsule and labrum to restore the labral bumper and tension the capsule laterally.
• Careful lateral traction of the capsule to avoid medial trapping, ensuring adequate tissue for repair.
• Inferior capsular shift or plication may be performed to address capsular laxity.
• Subscapularis tendon repaired over the capsule to restore anatomy.

Modern Complications & Outcomes

Complications

Outcomes

• Arthroscopic Bankart repair shows >85% success in preventing recurrent dislocation in appropriately selected patients.
• Functional outcomes focus on pain relief, restoration of stability, and return to pre-injury activity levels.
• Long-term outcomes depend on addressing concomitant lesions (e.g., Hill-Sachs, bone loss).

Classic Clinical Notes

Hawkins-Bankart2

• Complete the connection. You need to start the hole about 4 mm into the glenoid articular surface. Then pass the three sutures.
• Take out the forked retractor and pull the capsule laterally using a Kocher.
• Now the forked retractor goes onto the outside of the capsule and retracts away subscap.
• You need to pull the capsule laterally before pushing down on this retractor, or else you will trap the capsule medially and after repairing it down to the glenoid you will not have enough to suture back to the humerus.
• The medial stitch end is taken through first, and make sure this “pulls” the capsule as far lateral as possible.
• Then the Mayo needle is used on the lateral stitch end, placing this through the capsule in such a way as to pull down a cuff of capsule down onto the articular surface of the edge of the glenoid – thus re-creating a soft tissue labrum.
• Repeat this for all three sutures.
• Once the Bankart repair is complete, then you need to consider pulling the inferior capsule up.
• Again, use pop-off sutures and repair the capsule back onto its insertion.
• The subscap is then repaired over top of this.

Last Updated on January 25, 2026 by orthonet