Bankart variants in shoulder instability: Arthroscopic identification, management strategies, and functional outcomes

Objectives: Bankart lesion represents a spectrum of capsulolabral injury patterns including Perthes, anterior labroligamentous periosteal sleeve avulsion, glenolabral articular disruption, bony Bankart, and combined labroligamentous disruptions. In addition to technical errors, up to 25% failure rate following arthroscopic Bankart repair is related to missed or inadequately managed Bankart variants. The aim of our prospective study was to describe arthroscopic identification, lesion-specific management strategies, and evaluate functional outcomes following tailored arthroscopic stabilization. Materials and Methods: 46 patients underwent arthroscopic stabilization. Patients with prior surgery, glenoid bone loss >15%, multidirectional instability, Beighton score >4/9, or humeral avulsion of the glenohumeral ligament lesions were excluded. Bankart variants were identified intra-operatively, and management was tailored for each with adjunctive procedures. Functional outcomes were assessed preoperatively, 6 weeks, 3 months, 6 months, and 1 year postoperatively using the Constant–Murley score. Results: Seven Bankart variants were identified intra-operatively. Associated pathology was present in 47.83% of patients with Hill–Sachs being the most frequent (23.91%). Isolated Bankart repair was performed in 56.52% cases, while 21.74% required additional remplissage. Three anchors were used in the majority of cases (28/46; 60.87%). The mean Constant–Murley score improved from 59.78 ± 5.21 preoperatively to 90.98 ± 2.93 at 1 year ( p < 0.0001). All patients returned to sports by the final follow-up. Conclusion: Variant-based arthroscopic identification and tailored management of Bankart lesions result in significant functional improvement and excellent short-term outcomes. A structured surgical approach emphasizing lesion recognition, anatomic restoration, and selective augmentation may enhance stability and facilitate early return to sporting activity.