Definition
A compression defect on the inferior articular surface of the
humeral head due to impingement on the glenoid fossa during
recurrent dislocations.
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Radiographic Appearance
The lesion is visible on plain radiographs but a more
detailed view can be obtained through multiplanar reconstruction
using CT. The Bankart's lesion is usually seen as a small fracture
or a osteophitic deposit probably due to micro fractures, there is
often a corresponding Bankart's fracture of the inferior margin of
the glenoid fossa.
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Pathology
Traumatic detachment of the glenoid labrum. This lesion is seen in
over 85% of cases after a traumatic anterior dislocation. The
inferior gleno-humeral ligament, which is attached medially to the
inferior half of the anterior glenoid labrum, is the most important
of the ligaments that stabilise the shoulder. At the time of the
original injury, the humeral head, when it is forced out anteriorly
and inferiorly, first stretches the anterior capsule and the
inferior glenohumeral ligament. Then, as a result of traction, the
fibrous labrum is pulled off from the inferior half of the anterior
rim of the glenoid.
The Bankart's lesion: This results from the failure of healing
of the detachment of the anterior capsule and the labrum from the
glenoid margin. This leaves a pouch in front of the neck of the
scapula into which the head of the humerus easily redislocates. |
Treatment:
The treatment of this condition depends upon the age, sex and occupation
of the patient and the diability due to the frequency of the
dislocation. In patients past middle age with sedentary occupations,
conservative treatment is adopted. The patient is advised to avoid
extreme abduction and external rotation and instructed to do
internal rotation exercises to strengthen the internal rotator
muscles.
Surgical treatment
In younger individuals leading active lives, the best treatment is
to prevent excessive external rotation movement of the shoulder by
surgery. Many procedures have been described, but the following
procedures have proved successful.
1. Bankart Operation : In this operation, the Bankart lesion is
repaired by fixing the detached
labrum and capsule back to the anterior margin of the bony glenoid.
2. Putti Platt operation: The principle of this operation is to
tighten the lax anterior structures
by surgically double breasting the anterior joint capsule and
subscapularis. This prevents
excessive external rotation of the shoulder and redislocation.
3. Bristo-Helfet operation: In this operation the tip of the
coracoid process with the attached
muscles is osteotomised and reattached near to anterior margin of
the glenoid inn the
neck of scapula to form a dynamic anterior support.
4. Saha Operation : This procedures is based on the concept of
changing in the direction of
the articular surface of the glenoid by osteotomising the neck of
the scapula.
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Image 1 AP CT
Reconstruction showing Bankart's Lesion
Image 2 Axial section showing Bankart's
Lesion
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