Open Bankart Repair



Repair of the anterior capsule & avulsed labrum to anterior glenoid 

- anatomic repair


Usually combined with a capsular shift




Bony bankart > 25% glenoid





- beach chair position

- arm free

- Mayfield head ring / Spyder and Tmax




Can perform axillary incision

- in axillary fold

- mobilise skin to gain view

- more cosmetic scar

- more difficult visualisation


Axilary Incision 1Axillary Incision 2


Superficial dissection

- deltopectoral approach

- cephalic vein lateral with deltoid

- divide clavipectoral fascia

- mobilise lateral aspect conjoint tendon

- insert shoulder retractor deep to conjoint

- expose subscapularis with three sisters inferiorly


Increase exposure

- +/- partially detach conjoint tendon from coracoid

- ± partially release P major tendon (1.5 cm) from humerus

- can take of tip of coracoid (predrill for lateral repair)


Deep Dissection Options



Always leave inferior 1/4 of SSC

- protects AXN


L shaped incision in SSC / Capsulotomy 



Mark lower 3/4 of SSC

- ER shoulder

- use knife to divide muscle belly transversely

- expose capsule underneach

- use Cobb / dissecting scissors

- pass artery forcep up between capsule and SSC to rotator interval

- open interval further by spreading forceps

- tagging sutures in SSC medially (artery clips)

- divide SSC tendon vertically down onto forcep protecting capsule

- carefully elevate SSC from capsule medially using Cobb


Separate vertical incision in capsule

- right on humeral insertion

- superior and inferior

- stay on articular margin at all times

- can release down past 6 o'clock if wish to perform capsular shift

- usually don't perform horizontal / T shaped capsulotomy if repairing labrum

- T shaped capsulotomy used for MDI



- insert Fukuda retractor to expose joint

- displaces head posteriorly, exposes labrum

- inspect for pathology: labral detachment / loose bodies / loose capsule

- labrum mobilised

- bony glenoid roughened to bleeding surface

- suture anchors at 3, 4 & 5.30 

- sutures passed through labrum and capsule


Capsular plication / shift as required

- always repair with arm ER 30o to prevent loss of ER

- check ER with arm adducted and abducted

- need 50% of normal ER / other side


Tie medial labral / capsular sutures

- recheck ER as above


Subscapularis repaired / close rotator interval if shoulder still loose



- shoulder immobiliser for 6/52 with pendulars

- no ER

- elbow & hand exercises

- ROM exercises at 6/52 (passive, active assist, active)

- muscle strengthening at 3/12

- return to sport at 6/12




Rowe et al JBJS Am 1978

- classic quoted paper

- 5 recurrences in 145 patient(3.5%)


Flatow et al Orthopedics 2006

- 41 open stabilisations followed for average 6 years

- one recurrence

- average loss of ER 4o