Capsulolabral Reconstruction
What Is Capsulolabral Reconstruction (Bankart Repair)?
The shoulder is the most mobile joint in the body; this wide range of movement also makes it prone to dislocation. When the shoulder dislocates to the front (anterior instability), the labrum at the rim of the socket and the capsule and ligaments attached to it can be pulled off the bone; this is called a Bankart lesion. Repeated dislocations reinforce the looseness of these structures.
Capsulolabral reconstruction (Bankart repair) is surgery that aims to restore the front stability of the shoulder by reattaching the detached labrum and capsule to the rim of the socket and tightening the loosened capsule. For general information about shoulder dislocation and instability you can review the shoulder dislocation page, and for the basic structures of the shoulder the shoulder page.
Who Is a Candidate, and Who Is Not?
The decision for surgery rests not on imaging alone but on the frequency of dislocations, age, activity level and any accompanying bone loss. Assessment is essential to establish suitability.
- People with recurrent anterior shoulder dislocation and ongoing instability.
- Young, active people, especially those in contact and overhead sports, who carry a high risk of recurrence after a first dislocation.
- In patients with significant bone loss, soft-tissue repair alone may not be enough; in that case methods that add a bone block (e.g. Latarjet) come onto the agenda. For detail you can review the failed shoulder stabilization and bone loss page.
Preoperative Assessment
Before surgery the direction, frequency and mechanism of the dislocation are asked about; examination establishes the direction and degree of instability. Imaging aims to assess soft-tissue and bone loss together.
An X-ray shows the bone structure, MRI (MR arthrography where needed) shows the labrum and capsule, and CT shows bone loss at the glenoid and the humeral head. This assessment determines whether soft-tissue repair alone is enough or whether a method that adds bone is needed.
How Is the Surgery Performed?
Capsulolabral reconstruction is most often done arthroscopically and, in selected cases, with open surgery. The aim is to reattach the detached labrum and capsule to their anatomical position at the rim of the socket and to gather the loosened capsule at an appropriate tension.
The labrum is reattached with suture anchors placed in the bone; the loose capsule is tightened by folding it (plication) if needed. If bone loss is not significant, a graft is not required; with significant bone loss a method that adds a bone block or a different technique is chosen. The decision can also be updated according to the findings during surgery.
Anaesthesia and Duration
The operation is performed under general anaesthesia, usually with a regional nerve block; the block helps with pain control afterwards. The duration varies with whether the procedure is arthroscopic or open, the number of anchors and any accompanying repairs. Most patients are discharged the same day or after a short hospital stay.
The First Period After Surgery
In the early period the arm is supported in a sling to protect the repair. The duration of the sling and the movements allowed are set according to the type of repair; forceful movements that rotate the shoulder outwards are avoided early on.
Cold application and the pain medication advised by the doctor are used for pain and swelling. The aim of this period is to allow the repaired labrum to heal to the bone while preserving movement of the elbow, hand and neck.
Rehabilitation and Return to Sport
Physiotherapy progresses in stages: first protected range of motion, then widening the movement, then progressive strengthening, and finally sport-specific work. The programme is individualised to the patient and the repair performed.
Return to sport is guided by criteria rather than a fixed date: pain-free full movement, muscle strength close to the other shoulder, good joint control and sport-specific readiness. Return to contact and overhead sports usually takes longer; no fixed timeframe is promised.
Risks and Factors That Affect the Outcome
The procedure is generally safe; nevertheless, as with any surgery, certain risks are kept in mind: infection, joint stiffness, anchor-related problems, nerve or blood-vessel injury and, most importantly, recurrence of the instability.
The outcome is shaped by the degree of bone loss, the number of dislocations, the patient's age and sporting demands, the choice of the appropriate surgical method and adherence to rehabilitation. Unrecognised significant bone loss raises the risk of recurrence when only a soft-tissue repair is done; this is why the preoperative assessment is critical.
Alternative Methods
Capsulolabral reconstruction is not the only option for anterior shoulder instability. Non-surgical rehabilitation for low-risk patients after a first dislocation, methods that add a bone block such as Latarjet for those with significant bone loss, and revision approaches for previously failed stabilizations can all come onto the agenda. For detail on these you can review the Bankart repair and recurrent shoulder dislocation pages.
When Should You See a Doctor?
Having shoulder instability assessed early allows appropriate treatment to be planned before bone loss becomes established.
- Your shoulder has dislocated more than once, or you feel a sense of apprehension that it will dislocate with certain movements.
- After a first dislocation, especially if you are a young, active athlete, to assess the risk of recurrence and the options.
- After surgery there is increasing pain, fever, wound drainage or numbness or weakness in the arm; do not delay.
For the assessment and treatment of shoulder instability you can contact Assoc. Prof. Serkan Sürücü, and you can also review the other conditions covered within shoulder surgery.