Litchfield – Open Bankart

Modern Study Review (AI-Generated)

High-Yield Summary

The Open Bankart repair remains a foundational surgical technique for treating recurrent anterior shoulder instability due to a Bankart lesion (detachment of the anteroinferior labrum). While arthroscopic repairs have become more common, open Bankart repair is still indicated in select cases such as failed arthroscopic stabilization or significant capsulolabral damage. The procedure aims to restore the labral bumper and capsular tension to improve shoulder stability and function, minimizing recurrent dislocations.

Key Diagnostic Findings

Anatomy

• Glenoid labrum: Fibrocartilaginous rim that deepens the glenoid fossa and provides shoulder stability.
• Subscapularis muscle: Important anterior stabilizer; often incised during open repair.
• Anterior inferior glenohumeral ligament (IGHL): Key stabilizer involved in Bankart lesions.
• Humeral circumflex vessels: Must be identified and protected during surgery.

Clinical Presentation

• History of traumatic anterior shoulder dislocation.
• Recurrent episodes of instability or subluxation.
• Positive apprehension and relocation tests on physical exam.

Imaging

• MRI/MRA: Detects labral tears, capsular laxity, and associated Hill-Sachs lesions.
• X-rays: Assess for bony Bankart lesions and glenoid bone loss.

Classification Systems

• Bankart lesion: Detachment of the anteroinferior labrum from the glenoid rim.
• No formal classification system for Bankart lesions, but extent and associated bone loss guide treatment.

Current Gold Standard Treatment

Non-operative

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

Operative

• Indications: Recurrent instability, failed non-operative management, significant capsulolabral injury, or bone loss.
• Open Bankart Repair Technique:
• Deltopectoral approach with careful identification and ligation of the humeral circumflex vessels.
• Vertical incision through the subscapularis tendon with tagging for repair.
• Transverse capsular incision at approximately the 3 o’clock position to access the labrum.
• Use of suture anchors to reattach the labrum and recreate the labral bumper.
• “Pants-over-vest” capsular shift technique to tighten the capsule and improve stability.
• Repair of the subscapularis tendon to restore anterior shoulder function.

Modern Complications & Outcomes

Complications

Outcomes

• Open Bankart repair shows excellent long-term stability with recurrence rates <10% in properly selected patients.
• Functional outcomes depend on restoration of capsulolabral anatomy and subscapularis integrity.
• Postoperative rehabilitation protocols balancing protection and early motion optimize pain relief and function.

Classic Clinical Notes

Litchfield – Open Bankart

• Delto-pectoral approach, ties off humeral circumflex artery.
• Vertical subscapularis incision with tagging and separation from capsule.
• Transverse capsular incision at 3 o’clock position.
• Use of suture anchors and creation of a labral bumper.
• “Pants over vest” capsular shift technique.
• Repair of subscapularis tendon.

Postoperative protocol:

• Limit forward elevation (FE) to 90° for 4 weeks.
• No internal rotation allowed.
• External rotation limited to 30°.

Last Updated on January 25, 2026 by orthonet