Bankart Lesion: Symptoms, Types, Causes and Treatment

A Bankart lesion is one of the most common causes of recurrent shoulder instability, especially in young, active individuals. Whether you're an athlete, a patient, or a healthcare professional, understanding the symptoms, types, causes, and evidence-based treatments of Bankart lesions can help guide timely and effective management. In this comprehensive article, we break down the essential aspects of Bankart lesions, using the latest clinical research and expert consensus.

Symptoms of Bankart Lesion

Early recognition of a Bankart lesion is crucial for preventing chronic shoulder instability and further complications. The symptoms are often subtle after the first injury, but they can worsen or become persistent with repeated shoulder dislocations.

Symptom	Description	Typical Presentation	Source(s)
Instability	Feeling that the shoulder may "pop out"	After trauma or movement	4, 5
Pain	Discomfort or aching, usually in front	During or after activity	1, 5, 10
Limited motion	Reduced range, especially external rotation	Post-injury	7, 10
Recurrent dislocation	Multiple episodes of shoulder "giving way"	Especially in active patients	4, 8, 10

Table 1: Key Symptoms

Instability and Dislocation

• Shoulder instability is the hallmark symptom, often described as a sense of the joint being loose or prone to slipping out of place. This is typically most pronounced after a traumatic injury, such as a fall or direct blow 4.
• Recurrent dislocations are common, especially if the initial lesion is not treated adequately. Each subsequent dislocation can further damage the shoulder structures, leading to chronic instability 4, 8.

Pain and Functional Limitation

• Pain tends to be localized to the front of the shoulder, especially with movements such as overhead activities or certain sports. The pain may be sharp during a dislocation event and become a dull ache with chronic instability 1, 5.
• Restricted motion, particularly with external rotation and abduction, is observed in some individuals. This limitation might be mild but can impact athletic performance or everyday activities 7, 10.

Subtle or Latent Symptoms

• Some patients, especially those with only a mild initial injury, may have minimal symptoms until a second dislocation occurs.
• Early symptoms can sometimes be mistaken for a simple sprain or overuse injury.

Types of Bankart Lesion

Bankart lesions are not all the same. Understanding the different types helps in selecting the best diagnostic and therapeutic approach.

Type	Defining Feature	Clinical Importance	Source(s)
Soft-tissue Bankart	Detachment of labrum from glenoid rim	Most common, often isolated	5, 7, 9
Bony Bankart	Avulsion with fracture of glenoid rim	Greater instability risk	1, 3, 4, 6, 8, 10
Variants	Perthes, ALPSA, others	Diagnostic challenges	5

Table 2: Types of Bankart Lesion

Soft-tissue Bankart Lesion

• Definition: Detachment of the anteroinferior labrum from the glenoid rim without significant bone involvement 5.
• Clinical relevance: This is the classic Bankart lesion, often seen after a first-time dislocation, and typically treated with arthroscopic repair using suture anchors 7, 9.

Bony Bankart Lesion

• Definition: Involves a fracture of the anteroinferior glenoid rim along with labral detachment 1, 3, 4.
• Subtypes: Can be classified by the size of the bony fragment (small <12.5% of glenoid width, medium 12.5–25%, large >25%) 1, 3.
• Clinical implications: Larger bony Bankart lesions are associated with greater instability and potentially worse outcomes if left untreated 4, 6.

Variants

• Perthes and ALPSA Lesions: These are variants involving different patterns of labral and periosteal injury, which can complicate diagnosis and management 5.
• Imaging importance: MR arthrography is particularly useful for distinguishing between types and identifying subtle variants 5.

Causes of Bankart Lesion

Understanding how Bankart lesions develop can help with both prevention and early intervention, especially in at-risk populations.

Cause	Mechanism	At-Risk Groups	Source(s)
Traumatic injury	Forceful anterior shoulder dislocation	Young athletes, falls	4, 5, 6, 8, 10
Repetitive stress	Microtrauma from overhead activity	Throwers, swimmers	5
Recurrent dislocation	Cumulative damage to labrum/bone	Untreated instability	6, 8
Degeneration	Tissue wear from repeated events	Chronic cases	6

Table 3: Causes of Bankart Lesion

Traumatic Injuries

• Primary mechanism: The vast majority of Bankart lesions result from a forceful anterior dislocation—when the head of the humerus is pushed forward out of the socket, tearing the labrum and sometimes the bone 4, 5, 10.
• Common scenarios: Contact sports (football, rugby), traumatic falls, accidents.

Repetitive Microtrauma

• Overhead athletes: Activities involving repeated overhead motions (throwing, swimming) can lead to microtrauma, gradually weakening the labrum and predisposing it to a tear 5.
• Less common: Most Bankart lesions are still related to acute trauma rather than overuse.

Recurrent Dislocations and Chronic Instability

• Cycle of injury: If the initial lesion is not repaired, each new dislocation further damages both the labrum and surrounding ligaments, increasing the risk of a bony Bankart lesion and chronic instability 6, 8.
• Degenerative changes: Histologic studies show that repeated dislocations can lead to degeneration of the ligamentous tissue, making surgical repair more challenging and less likely to succeed 6.

Treatment of Bankart Lesion

Modern treatment of Bankart lesions is highly individualized, depending on the type, size, chronicity, and patient activity level. Both surgical and non-surgical options exist, but evidence strongly favors surgical repair for active patients with recurrent instability.

Treatment	Indication	Outcome Highlights	Source(s)
Arthroscopic repair	Small/medium lesions, acute cases	High success, less stiffness	1, 7, 8, 9, 10
Open repair	Large lesions, failed arthroscopy	Similar stability, less ROM	7, 9
Non-surgical	First dislocation, low-demand patient	Higher recurrence risk	4, 5
Imaging diagnosis	US, MR arthrography for planning	Accurate detection	2, 5

Table 4: Bankart Lesion Treatments

Arthroscopic Repair

• Indications: Preferred for small to medium-sized Bankart lesions (<25% of glenoid width), especially in acute cases 1, 8, 10.
• Technique: Involves reattaching the labrum (and bone, if present) to the glenoid using suture anchors 1, 10.
• Outcomes:
  • High rates of restored stability and shoulder function 8, 10.
  • Minimally invasive, with quicker recovery and better preservation of range of motion compared to open surgery 7, 9.

Open Surgical Repair

• Indications: Sometimes considered for larger bony lesions or when arthroscopic repair fails 7, 9.
• Outcomes: Comparable stability to arthroscopy, but with a slightly higher risk of post-op stiffness and reduced range of motion 7.

Non-Surgical Management

• When used: May be considered in select patients after a first-time dislocation, especially if they are older or not highly active 4, 5.
• Risks: Non-surgical management carries a higher risk of recurrent instability, especially in younger, active populations 4.

Imaging and Diagnosis

• Ultrasound (US): Useful for initial detection, especially with axillary approach (sensitivity 88.6%) 2.
• MR arthrography: Gold standard for evaluating labral tears and distinguishing among variants 5.
• CT: Essential for quantifying bone loss in bony Bankart lesions and for surgical planning 1, 3.

Special Considerations

• Acute vs. Chronic: Acute lesions (<3 months) respond better to repair; chronic lesions have more degeneration and less favorable outcomes 8.
• Size matters: Restoration of soft tissue tension is sufficient for small lesions; medium or larger lesions benefit from anatomical reconstruction of bone 1.
• Viability of tissue: Even chronic bony fragments are often viable for repair, but ligaments may degenerate with repeated dislocations, complicating surgery 6.

Conclusion

Bankart lesions are a critical consideration in anyone presenting with recurrent shoulder instability, particularly after traumatic injury. Early recognition, appropriate imaging, and tailored treatment can restore shoulder function and prevent chronic complications.

Key Takeaways:

• Symptoms: Instability, pain, limited motion, and recurrent dislocations are classic signs.
• Types: Soft-tissue and bony Bankart lesions, with variants, each requiring different management strategies.
• Causes: Most commonly result from traumatic anterior shoulder dislocation, but can also be due to repetitive microtrauma or chronic instability.
• Treatment: Arthroscopic repair is the standard for most cases, with open surgery reserved for select situations; imaging is essential for accurate diagnosis and surgical planning.

By understanding the nuances of Bankart lesions, patients and clinicians can work together to achieve the best outcomes and restore full, pain-free shoulder function.