What are the chances of a repeat dislocation after a Bankart injury?
The chance of the shoulder dislocating after a Bankart injury depend on the age of the patient. Younger patients are most likely to sustain a Bankart injury if their shoulder dislocates, and are therefore more likely to have a repeat, or recurrent, dislocation. Statistically, the chances of redislocating the shoulder are greater than 80% in patients younger than 30 years of age. Over 30 years old, the chance of a repeat dislocation drops significantly.
Is surgery after an initial dislocation recommended?
Some orthopedic surgeons recommend surgery to repair a Bankart lesion after a shoulder dislocation in young athletes. The usual treatment is a period of rest, followed by aggressive physical therapy. Then a gradual return to activities. If the shoulder dislocates again, surgery is usually considered.
However, some orthopedic surgeons will repair a Bankart lesion after one dislocation in young athletes. Because the chance of repeat dislocation is so high, especially in athletes who participate in contact sports, this type of immediate Bankart repair can be justified.
That said, there is no reason why surgery cannot be delayed, and physical therapy can be attempted. The only concern is that a Bankart repair takes AT LEAST six months to heal, and many patients want to return to activity as soon as possible, without worrying about a repeat dislocation.
What is the best way to proceed?
There is no "right" answer to this question. It is true that young athletes, especially those who participate in contact sports (e.g. football), who dislocate their shoulder will have a very high chance of a repeat dislocation without surgery.
It is important to remember that a Bankart repair is a significant surgery, and recovery is not easy. Physical therapy can be attempted, but the patient must understand that a repeat dislocation is possible.
The decision is also clouded by age. As patients reach their 30s and later, the chance of repeat dislocation begins to drop quickly. Patients over 30 generally do not need surgery unless repeat dislocations become a problem.
