Der klassische Bankart

The classical Bankart lesion is frequently the result of a traumatic anterior shoulder dislocation and male athletes in contact sports are predominantly affected. Due to avulsion of the anteroinferior labrum from the anteroinferior glenoid rim, there is an increased translation between the humeral head and the glenoid cavity often resulting in persistent anterior shoulder instability. Concomitant injuries particularly include impression fractures of the posterosuperior humeral head (Hill-Sachs lesion) and bony glenoid rim fractures (bony Bankart fractures). As young patients and those involved in demanding sports (contact sports) have a high risk of recurrence, surgical treatment is increasingly being primarily recommended in these patient collectives. In recent years arthroscopic labrum-capsule reconstruction has become established as the standard procedure. With the patient in the side or beach chair position the labrum-capsule complex is reattached to the anterior glenoid rim by multiple suture anchor systems. An additional soft tissue remplissage or bone augmentation of the anteroinferior glenoid rim should be carried out by iliac crest autograft or the Latarjet procedure, when a large Hill-Sachs lesion or a bony glenoid deficit (off-track lesion) is present. The long-term results in the literature show very heterogeneous results. Long-term studies with a high level of evidence are rare. Arthroscopic anterior stabilization is superior to conservative treatment in young and athletically active patients. The recurrence rate after 10–13 years in level 3 and 4 studies is ca. 30%, whereby the size of the Hill-Sachs lesion or bony deficit of the glenoid have rarely been quantified and treated according to the stage.