A Bankart tear is a tear of the anterior-inferior labrum and attached capsule and ligaments from the rim of the glenoid, most commonly caused by an anterior shoulder dislocation. The tear destabilizes the shoulder joint and, left untreated in younger active patients, leads to recurrent dislocations and progressive bone loss. Dr. Chudik treats the full spectrum of Bankart injuries, including the bony variant that involves fracture of the glenoid rim.
What Is a Bankart Tear?
The labrum is a firm soft-tissue rim attached around the edge of the glenoid socket. It deepens the socket and anchors the glenohumeral ligaments that connect the humeral head to the glenoid. When the shoulder dislocates anteriorly, the humeral head is driven forward out of the socket and tears the labrum and the attached ligaments off the anterior-inferior glenoid rim. This is a Bankart lesion. If the dislocating force also fractures a portion of the bony glenoid rim along with the labrum, the injury is called a bony Bankart lesion.
Bankart tears can occur in three anatomic regions, each with implications for treatment:
- Anterior Bankart: the classic lesion, from standard anterior dislocation
- Posterior Bankart: from posterior instability, common in football linemen and weightlifters
- Inferior Bankart: often associated with multidirectional instability or significant trauma
The torn labrum does not heal back to the glenoid without surgical fixation, because the shoulder’s motion and the instability of the torn fragment prevent stable contact with the bone.
Causes and Risk Factors
- Anterior shoulder dislocation, the most common mechanism
- Posterior dislocation or repetitive posterior loading (blocking in football, bench pressing)
- Shoulder subluxation events that tear but do not fully dislocate the labrum
- Contact sports, overhead sports, and occupations with fall risk
- Young age at first dislocation increases the risk of a significant Bankart injury
Symptoms
- Shoulder instability or a feeling the shoulder is going to “come out” in specific positions
- Apprehension with the arm abducted and externally rotated for anterior tears, or with the arm forward flexed and internally rotated for posterior tears
- Recurrent dislocations or subluxations
- Deep shoulder pain with overhead activity, catching, or clicking
- Weakness from guarding or from associated rotator cuff injury
Diagnosis
Dr. Chudik’s evaluation includes the mechanism of injury, the specific positions that produce apprehension, and a physical examination with provocative maneuvers tailored to the suspected tear location. X-rays evaluate for glenoid bone loss and humeral head impression defects. MRI arthrogram characterizes the labrum, capsule, and cartilage; contrast distends the joint and improves detection of Bankart tears. CT is added when significant bone loss is suspected, because quantifying glenoid bone loss drives surgical decision-making. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical management has a limited role in Bankart tears because the labrum does not heal back to the glenoid without fixation. It is appropriate for lower-demand older patients, for patients unwilling to undergo surgery, and as a trial before recurrent instability develops.
For active patients, arthroscopic Bankart repair is the standard treatment. Dr. Chudik reattaches the torn labrum and capsule to the glenoid rim with suture anchors through small arthroscopic incisions. For tears that involve glenoid bone loss greater than 13 to 15 percent, Dr. Chudik performs Arthroscopic Bony Bankart Repair and Glenoid Reconstruction, a technique he developed to address bone loss arthroscopically where conventional treatment requires open surgery with larger incisions and more soft-tissue disruption.
Recovery and Outcomes
Recovery after arthroscopic Bankart repair typically includes four to six weeks of sling protection, progressive motion over two to three months, and strengthening over three to four months. Return to contact or overhead sport is typically five to six months. Outcomes are better when the tear is repaired before multiple dislocations, because the labral tissue is healthier and the glenoid bone is preserved. Delayed treatment allows bone loss to accumulate and increases the complexity of surgery.
When to See Dr. Chudik
Schedule an evaluation after any shoulder dislocation, when the shoulder feels unstable in specific positions, or if prior treatment has not resolved instability symptoms. Call 630-324-0402 or request an appointment online.