THE ORTHOPAEDIC GROUP, LLC Alan M. Reznik, M.D., M.B.A. Print page for easy referral. |
Labral or Bankart Lesion Repair
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The fragility of the shoulder is reinforced by a series of ligaments, and a rim of tissue that surrounds the cavity called the glenoid labrum. If excessive force is applied to the arm, the shoulder may become “dislocated,” that is, the head of the humerus may be forced out of the cavity and the supporting ligaments of the shoulder may be torn, displaced or stretched out of shape.
When the shoulder dislocates, the smooth cartilage surface of the humerus (“ball”) slides over the rim of the glenoid portion of the scapula (the lip of the cup or golf tee). At the time of shoulder dislocation, or more often at the time of relocation, this can cause a complication
and damage to the head of the humerus (the “ball” portion of the joint.) This occurs when the humeral head passes into, or out of, the socket as the ball is impinged against the sharp glenoid rim. The back of the ball can be fractured or dented just like a dent in your car after a fender bender. The dent from this injury is referred to as a “Hill Sachs Lesion.” An x-ray of a dislocated shoulder is shown below in figure 1a.
An arthroscopic photo of the damage to the ball is shown below. The larger this dent is, the easier the shoulder will dislocate again. At the same time the ligaments in the front of the shoulder are avulsed or torn off the rim of the Glenoid (as shown in the drawing above). It is the combination of the dent size and ligament damage that is the true measure of future instability of the shoulder.
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| “Hill Sach’s lesion” - (Damage to the ball of the ball and socket after dislocation) © AM Reznik MD MBA 2007 |
A Bankart procedure, Labral repair or Gleno-humeral ligament repair, are surgical techniques for the repair of the damage from a single or recurrent shoulder joint dislocations. In this procedure, the torn labrum (or lip of the socket) with the attached ligaments are re-attached to the proper place in the shoulder joint. By re-attaching these ligaments and cartilage we can prevent future dislocations. With the proper tightening of the lining the Hill Sachs Lesion (the dent) will not hit the rim with routine motion. The shoulder is made stable and the re-injury risk is greatly reduced by avoiding “dent/ rim” contact. Dr. Reznik does this repair through the arthroscope with sutures and tiny absorbable anchors. The goal is to restore normal function in a minimally invasive way as an out patient procedure. If the ligaments alone are torn or stretched and the labrum is still attached they can be repaired in a similar manor.
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| Arthroscopic View of a “Labral” tear with the shoulder ligaments detached from the Labrum (lip of the Socket). In this view the “Ball” is sitting on the edge of the “Socket”. © AM Reznik MD MBA 2007 |
Frequently the ligaments and the capsule lining are stretched out of shape. This may also cause instability, subluxation or recurrent dislocations. Many of these patients cannot work overhead or throw any object. They also have difficulty with overhead sports. When this occurs the loose capsule can be tightened at the same time the ligaments are repaired. This is referred to a “Capsular Shift” procedure.
Dr. Reznik also performs this surgery with a minimally invasive technique through an arthroscope (fiber optic scope) with little disruption to the other shoulder structures. The surgery is done on an out patient basis which allows patients to be home in a few hours instead of days. On rare occasions the dent is so large that is needs to be grafted. Arthroscopic assisted methods are available for this procedure as well.
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Lead Suture being passed through a torn ligament/Labrum |
Permanent Suture with anchor positioned in the bone |
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Repair complete – Humeral head (ball) now centered in the Glenoid (socket) |
Page 2: Bankart or Labral Repair Recovery Plan