Bankart set out to identify the lesion behind recurrent anterior dislocation of the shoulder and to describe an operation that repairs it directly.
One surgeon's series of 27 consecutive operated cases, London.
Methods
Indication
Recurrent anterior dislocation of the shoulder
Approach
Deltopectoral approach with coracoid tip osteotomy and subscapularis division
Capsule edge sutured to the raw anterior glenoid margin through drill holes
Outcomes
Recurrence of dislocation
Range of shoulder movement
Key Findings
All 27 consecutive cases showed the glenoid ligament torn from the anterior glenoid margin, which Bankart described as a constant and uncomplicated anatomical lesion.
No case showed any of the causes proposed earlier, including capsular laxity, muscle weakness, glenoid fracture or other bony abnormality.
Bankart attributed the dislocation that later recurs to a fall on the back of the shoulder or on a backward‑directed elbow, not to a fall on the abducted arm.
A torn fibrous capsule heals soundly, but the detached glenoid ligament shows no tendency to reattach to bone, so the defect stays permanent.
After repair, every patient regained full shoulder movement and none had a recurrent dislocation.
Bankart judged that earlier operations probably work by restricting shoulder motion, helped by patients avoiding provocative positions, and not by correcting the defect.
Board pearl
Bankart's essential lesion of recurrent anterior dislocation is detachment of the glenoid ligament from practically the whole anterior half of the glenoid margin, and the only rational treatment is to reattach it (or the capsule) to bone.
Bankart's operation for recurrent dislocationBankart, Br J Surg 1938
Exposure5‑inch incision along the anterior border of the deltoid, from the clavicle over the coracoid.
CoracoidCoracoid tip osteotomized about half an inch from its end and turned down with its three attached muscles.
SubscapularisArm externally rotated, then the subscapularis tendon divided near the lesser tuberosity and retracted medially.
GlenoidThin bone shaving raised from the front of the scapular neck to give a raw surface.
FixationTwo pairs of holes made through the glenoid margin, and sutures tie the capsule edge down onto raw bone.
ClosureArm bandaged to the side for a month, then active movement begins.
Authors' conclusion
Recurrent dislocation is due to a wide detachment of the glenoid ligament from the anterior margin of the glenoid cavity.
Bankart set out to identify the lesion behind recurrent anterior dislocation of the shoulder and to describe an operation that repairs it directly.
One surgeon's series of 27 consecutive operated cases, London.
Methods
Indication
Recurrent anterior dislocation of the shoulder
Approach
Deltopectoral approach with coracoid tip osteotomy and subscapularis division
Capsule edge sutured to the raw anterior glenoid margin through drill holes
Outcomes
Recurrence of dislocation
Range of shoulder movement
Key Findings
All 27 consecutive cases showed the glenoid ligament torn from the anterior glenoid margin, which Bankart described as a constant and uncomplicated anatomical lesion.
No case showed any of the causes proposed earlier, including capsular laxity, muscle weakness, glenoid fracture or other bony abnormality.
Bankart attributed the dislocation that later recurs to a fall on the back of the shoulder or on a backward‑directed elbow, not to a fall on the abducted arm.
A torn fibrous capsule heals soundly, but the detached glenoid ligament shows no tendency to reattach to bone, so the defect stays permanent.
After repair, every patient regained full shoulder movement and none had a recurrent dislocation.
Bankart judged that earlier operations probably work by restricting shoulder motion, helped by patients avoiding provocative positions, and not by correcting the defect.
Board pearl
Bankart's essential lesion of recurrent anterior dislocation is detachment of the glenoid ligament from practically the whole anterior half of the glenoid margin, and the only rational treatment is to reattach it (or the capsule) to bone.
Bankart's operation for recurrent dislocationBankart, Br J Surg 1938
Exposure5‑inch incision along the anterior border of the deltoid, from the clavicle over the coracoid.
CoracoidCoracoid tip osteotomized about half an inch from its end and turned down with its three attached muscles.
SubscapularisArm externally rotated, then the subscapularis tendon divided near the lesser tuberosity and retracted medially.
GlenoidThin bone shaving raised from the front of the scapular neck to give a raw surface.
FixationTwo pairs of holes made through the glenoid margin, and sutures tie the capsule edge down onto raw bone.
ClosureArm bandaged to the side for a month, then active movement begins.
Authors' conclusion
Recurrent dislocation is due to a wide detachment of the glenoid ligament from the anterior margin of the glenoid cavity.