The shoulder joint is the most mobile joint in the body — our ability to move the arm freely in every direction is thanks to this joint’s design. But the price of this freedom of movement is loss of stability. The shoulder is like a golf ball resting on a tee: because the bony structure is shallow, stability depends largely on the labrum (joint lip), capsule, and ligaments. When these structures are damaged in a first dislocation, the door is opened to recurrent dislocations.
A Bankart lesion is the detachment of the labrum (joint lip) at the front-lower part of the shoulder joint from the glenoid bone, and it is the most common structural damage seen after a traumatic shoulder dislocation. The labrum deepens the joint socket by up to fifty percent, contributing to stability. When this structure tears, the socket becomes shallower and the humeral head slips forward much more easily. The rate of detecting a Bankart lesion by MRI after a first dislocation is above eighty percent.
The risk of recurrence is directly related to the patient’s age. While recurrent dislocation develops in seventy to ninety percent of patients who have their first dislocation under the age of twenty, this rate falls below ten percent over the age of forty. The reason the recurrence risk is so high in young athletes is both their high activity level and the difficulty of stable spontaneous healing with scar tissue, given the elastic nature of their soft tissues.
Every recurrent dislocation causes additional damage to the joint. Wear and bone loss develop in the glenoid (socket) and the humeral head. The Hill-Sachs lesion, a depression defect on the back-upper part of the humeral head, deepens with each dislocation. When bone loss exceeds a certain threshold, soft-tissue repair alone is not enough and bone grafting procedures are required. For this reason, postponing surgery in patients with recurrent dislocations is usually a disadvantage.
Arthroscopic Bankart repair is the standard surgical treatment for recurrent shoulder dislocation. Through three or four small incisions, a camera and special suturing instruments are placed into the joint. The detached labrum is reattached to the glenoid bone with the help of suture anchors (mini buttons screwed into the bone), and the loosened capsule is tightened and sutured. The operation usually takes one to one and a half hours, and the patient can be discharged the same day.
If glenoid bone loss is above twenty-five percent, the failure rate of arthroscopic Bankart repair increases. In this case, the Latarjet procedure is preferred. In the Latarjet operation, a block of bone taken from the coracoid process is screwed onto the front of the glenoid to compensate for the bone loss, and additional dynamic stability is provided by a tendon transfer. The procedure is chosen by calculating the bone-loss ratio with CT.
After surgery, the arm is kept in a sling for four to six weeks. In the first six weeks, joint stiffness is prevented with passive movement exercises. From the sixth week, active movements begin, and from the third month, strengthening exercises. Return to contact sports is usually evaluated at the sixth month. The recurrence rate after arthroscopic Bankart repair is between five and ten percent; the return-to-sport rate is above ninety percent.
What should you do after a shoulder dislocation? Once the first dislocation has been reduced, be sure to have a shoulder MRI to assess labral and bone damage. If you are a young and active patient, you should seriously consider surgical treatment even after the first dislocation — each recurrent dislocation makes the surgery harder and its outcome less predictable.