A Bankart lesion is a tear of the anteroinferior (front-bottom) labrum of the shoulder — the most common structural injury resulting from an anterior shoulder dislocation. When the humeral head is forced forward out of the socket, it tears this critical stabilizing structure away from the glenoid rim, creating an anatomic defect that predisposes the shoulder to recurrent instability.
Bankart lesions are almost always the result of a shoulder dislocation and are frequently accompanied by a Hill-Sachs impaction fracture on the humeral head. In overhead athletes, a concurrent SLAP tear may be present, and chronic instability can accelerate shoulder cartilage damage over time.
Causes
Anterior shoulder dislocation.
A Bankart lesion is present in the majority of first-time anterior shoulder dislocations, particularly in young, active patients. The labrum and attached inferior glenohumeral ligament are stripped from the anterior-inferior glenoid as the humeral head translates forward during the dislocation event.
Bony Bankart lesion.
When the force of dislocation is significant, a fragment of the glenoid bone may be avulsed along with the labrum, creating a bony Bankart lesion. This significantly worsens the structural deficit and increases the complexity of surgical repair.
Symptoms
Following reduction of an acute dislocation, patients experience persistent anterior shoulder pain, apprehension with the arm in the throwing position (abducted and externally rotated), and a sensation of the shoulder "slipping" or "giving way." Recurrent subluxations or dislocations are common without definitive treatment, particularly in patients under the age of 25.
Diagnosis
A physical exam by a doctor includes the apprehension test and relocation test, which are highly specific for anterior shoulder instability. X-rays identify bony lesions including the Hill-Sachs impaction fracture on the humeral head. An MRI arthrogram is the preferred imaging modality, providing excellent visualization of the anteroinferior labrum, capsulolabral complex, and any associated bony defects — essential information for pre-surgical planning. MRI also evaluates the rotator cuff and biceps anchor simultaneously, as rotator cuff tears and SLAP lesions are recognized co-injuries that should not be missed before surgery.
Lesion classification
Doctors classify Bankart lesions based on the presence of associated bony injury and lesion variants.
- Soft tissue Bankart lesion: Labral and capsulolabral avulsion without bone loss. Most amenable to arthroscopic repair.
- Bony Bankart lesion: Labral avulsion with associated glenoid bone fragment. May require open surgery or bone grafting depending on the size of the defect.
- ALPSA lesion: Anterior Labroligamentous Periosteal Sleeve Avulsion — a variant where the labrum slides medially rather than detaching completely.
- HAGL lesion: Humeral Avulsion of Glenohumeral Ligament — a related injury where the inferior glenohumeral ligament avulses from the humeral side rather than the glenoid.
Treatments
Treatment depends on the type of lesion, presence of bone loss, patient age, and activity level.
After the initial dislocation is reduced, rest, ice, a sling for comfort, and anti-inflammatory medications are recommended.
Low-demand or older patients: A trial of physical therapy and activity modification may be appropriate for older, lower-demand patients with minimal instability symptoms, though recurrence rates are higher without surgical repair.
Bankart lesion in young and active patients
Surgery is often advised for young or active patients given the high recurrence rate without repair. Arthroscopic Bankart repair uses suture anchors to reattach the torn labrum and capsule to the anterior glenoid rim, restoring the normal bumper effect. After surgery, a thorough physical therapy regiment is critical to healing and recovering function.
Bony Bankart lesion or significant glenoid bone loss
A Latarjet procedure is recommended when significant glenoid bone loss (typically greater than 20–25%) is present or when arthroscopic repair has failed. A piece of the coracoid process is transferred to the glenoid to reconstruct the bony defect and provide additional stability.
Recurrent dislocations after prior repair
Revision surgery is individualized based on the cause of failure, the presence of bone loss, and the patient's goals. Options include revision arthroscopic repair, Latarjet procedure, or glenoid bone grafting.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Shoulder MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.