Bankart lesion

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Bankart lesions are injuries specifically at the anteroinferior aspect of the glenoid labral complex, and represent a common complication of anterior shoulder dislocation ~~and~~. They are frequently seen in association with a Hill-Sachs lesion.

Terminology

Strictly speaking, a "Bankart lesion" refers to an injury of the labrum and associated glenohumeral capsule/ligaments (see History and etymology below). Injury to these reinforcing soft tissue structures is thought to predispose to recurrent dislocation ⁷.

The term "bony Bankart" (contrasted with "fibrous Bankart") is often used to refer to fracture of the adjacent anteroinferior glenoid, an injury which also commonly occurs in the setting of anterior glenohumeral dislocation. Structurally, this fracture is thought to be less contributory to anterior instability.

Pathology

~~They~~Bankart lesions occur as a direct result ~~from~~of anterior dislocation of the humeral head, whereby the humerus is compressed against the labrum. There is detachment of the anterior inferior labrum ~~from~~ from the underlying glenoid ~~as a direct result~~, and the labral tear may further extend further superiorly or posteriorly.

Impaction fracture of the ~~anteriorly dislocated humeral head compressing against the labrum. It may be~~ ~~labral~~ ~~only ("soft Bankart"), or involve the bony~~anteroinferior glenoid margin ~~(impaction fracture) and this is called a "bony Bankart~~commonly co-occurs.

"Soft"~~. Soft~~ Bankart lesions are more common than ~~bony~~"bony" Bankart lesions ⁵. ~~Additionally, antero-inferior labral tear may further extend superiorly, or posteriorly.~~

Associations

The same mechanism of compression can result in a Hill-Sachs lesion. Bankart and Hill-Sachs lesions are 11x more likely to occur together than isolated injuries ⁵.

Variants

Perthes lesion of the shoulder: tear of the glenoid labrum, but with an intact scapular periosteum ²
anterior labroligamentous periosteal sleeve avulsion (ALPSA): mobilised labrum remains attached to the glenoid periosteum

Radiographic features

Plain radiograph

~~bony Bankart lesion may be seen as a~~+- fracture of the anteroinferior aspect of the glenoid ⁴

CT

~~on non-contrast~~glenoid labrum is not commonly visualized by CT, ~~a fracture~~although CT arthrography may ~~be seen~~demonstrate labral avulsion ⁴
+/- fracture at the anteroinferior aspect of the glenoid ~~(i.e. bony Bankart)~~
~~CT arthrography may demonstrate labral avulsion (i.e. soft Bankart)~~ ⁴

MRI

~~displaced~~frank displacement/separation of the anterior glenoid labrum, with ~~bone~~or without glenoid fracture fragment
linear high T2/PD intensity ~~coursing~~ through the ~~normally low signal antero-inferior~~non-displaced anteroinferior labrum, indicating tear
abnormally small or absent anterior labrum ³
~~the~~ double axillary pouch sign ~~on coronal~~ (coronal MR arthrogram ~~is a~~) - specific sign for an anteroinferior labral tear

Treatment and prognosis

Bankart lesions do heal, and therefore early surgical intervention (if any) is not required. In Bankart repairs, the labral fragment is sutured back to the glenoid rim using suture anchors.

Differential diagnosis

A number of lesions are closely related have similar appearances, see anterior glenohumeral injury for discussion of the differences.

History and etymology

ItThis lesion is named after Arthur Sydney Blundell Bankart(1879–1951) ⁶, a British orthopedic surgeon. In his original paper, Bankart described avulsive injury of the fibrocartilaginous soft tissues along the anteroinferior glenohumeral joint occurring in association with anterior shoulder dislocation. Although he acknowledges the frequent co-occurrence of glenoid and humeral fracture with these injuries, Bankart posited that it injury to the soft tissue structures specifically predisposed to recurrent dislocation ⁷. For this reason, some insist that the term "Bankart lesion" be reserved soft tissue injury.

-<p><strong>Bankart lesions</strong> are a common complication of anterior shoulder dislocation and are frequently seen in association with a <a href="/articles/hill-sachs-lesion">Hill-Sachs lesion</a>.</p><h4>Pathology</h4><p>They result from detachment of the anterior inferior <a href="/articles/glenoid-labrum">labrum</a> from the underlying <a href="/articles/glenoid">glenoid</a> as a direct result of the anteriorly dislocated humeral head compressing against the labrum. It may be <a href="/articles/glenoid-labrum">labral</a> only ("soft Bankart"), or involve the bony glenoid margin (impaction fracture) and this is called a "bony Bankart". Soft Bankart lesions are more common than bony Bankart lesions <sup>5</sup>. Additionally, antero-inferior labral tear may further extend superiorly, or posteriorly.</p><h5>Associations</h5><p>The same mechanism of compression can result in a Hill-Sachs lesion. Bankart and Hill-Sachs lesions are 11x more likely to occur together than isolated injuries <sup>5</sup>.</p><h5>Variants</h5><ul>
+<p><strong>Bankart lesions</strong> are injuries specifically at the anteroinferior aspect of the glenoid labral complex, and represent a common complication of anterior shoulder dislocation. They are frequently seen in association with a <a href="/articles/hill-sachs-lesion">Hill-Sachs lesion</a>. </p><h4>Terminology</h4><p>Strictly speaking, a "Bankart lesion" refers to an injury of the labrum and associated glenohumeral capsule/ligaments (see <em>History and etymology</em> below). Injury to these reinforcing soft tissue structures is thought to predispose to recurrent dislocation <sup>7</sup>.</p><p>The term "bony Bankart" (contrasted with "fibrous Bankart") is often used to refer to fracture of the adjacent anteroinferior glenoid, an injury which also commonly occurs in the setting of anterior glenohumeral dislocation. Structurally, this fracture is thought to be less contributory to anterior instability.</p><h4>Pathology</h4><p>Bankart lesions occur as a direct result of anterior dislocation of the humeral head, whereby the humerus is compressed against the labrum. There is detachment of the anterior inferior <a href="/articles/glenoid-labrum">labrum</a> from the underlying <a href="/articles/glenoid">glenoid</a>, and the labral tear may further extend further superiorly or posteriorly. </p><p>Impaction fracture of the anteroinferior glenoid margin commonly co-occurs.</p><p>"Soft" Bankart lesions are more common than "bony" Bankart lesions <sup>5</sup>. </p><h5>Associations</h5><p>The same mechanism of compression can result in a Hill-Sachs lesion. Bankart and Hill-Sachs lesions are 11x more likely to occur together than isolated injuries <sup>5</sup>.</p><h5>Variants</h5><ul>
~~-</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>bony Bankart lesion may be seen as a fracture of the anteroinferior aspect of the glenoid <sup>4</sup>~~
+</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>+- fracture of the anteroinferior aspect of the glenoid <sup>4</sup>
~~-<li>on non-contrast CT, a fracture may be seen at the anteroinferior aspect of the <a href="/articles/glenoid">glenoid</a> (i.e. bony Bankart)</li>~~
~~-<li>CT arthrography may demonstrate labral avulsion (i.e. soft Bankart) <sup>4</sup>~~
+<li>glenoid labrum is not commonly visualized by CT, although CT arthrography may demonstrate labral avulsion <sup>4</sup>
+</li>
+<li>+/- fracture at the anteroinferior aspect of the <a href="/articles/glenoid">glenoid</a>
~~-<li>displaced anterior glenoid labrum with bone</li>~~
~~-<li>linear high T2/PD intensity coursing through the normally low signal antero-inferior labrum</li>~~
+<li>frank displacement/separation of the anterior glenoid labrum, with or without glenoid fracture fragment</li>
+<li>linear high T2/PD intensity through the non-displaced anteroinferior labrum, indicating tear </li>
~~-<li>the <a href="/articles/double-axillary-pouch-sign">double axillary pouch sign</a> on coronal MR arthrogram is a specific sign for an anteroinferior labral tear</li>~~
-</ul><h4>Treatment and prognosis</h4><p>Bankart lesions do heal, and therefore early surgical intervention (if any) is not required. In Bankart repairs, the labral fragment is sutured back to the glenoid rim using suture anchors.</p><h4>Differential diagnosis</h4><p>A number of lesions are closely related have similar appearances, see <a href="/articles/anterior-glenolabral-injuries">anterior glenohumeral injury</a> for discussion of the differences.</p><h4>History and etymology</h4><p>It is named after <strong>Arthur Sydney Blundell Bankart</strong>, British orthopedic surgeon.</p><h4>See also</h4><ul><li><a href="/articles/eponymous-fractures">eponymous fractures</a></li></ul>
+<li>
+<a href="/articles/double-axillary-pouch-sign">double axillary pouch sign</a> (coronal MR arthrogram) - specific sign for an anteroinferior labral tear</li>
+</ul><h4>Treatment and prognosis</h4><p>Bankart lesions do heal, and therefore early surgical intervention (if any) is not required. In Bankart repairs, the labral fragment is sutured back to the glenoid rim using suture anchors.</p><h4>Differential diagnosis</h4><p>A number of lesions are closely related have similar appearances, see <a href="/articles/anterior-glenolabral-injuries">anterior glenohumeral injury</a> for discussion of the differences.</p><h4>History and etymology</h4><p>This lesion is named after <strong>Arthur Sydney Blundell Bankart </strong>(1879–1951) <sup>6</sup>, a British orthopedic surgeon. In his original paper, Bankart described avulsive injury of the fibrocartilaginous soft tissues along the anteroinferior glenohumeral joint occurring in association with anterior shoulder dislocation. Although he acknowledges the frequent co-occurrence of glenoid and humeral fracture with these injuries, Bankart posited that it injury to the soft tissue structures specifically predisposed to recurrent dislocation <sup>7</sup>. For this reason, some insist that the term "Bankart lesion" be reserved soft tissue injury.</p><h4>See also</h4><ul><li><a href="/articles/eponymous-fractures">eponymous fractures</a></li></ul>

References changed:

6. Somford M, Nieuwe Weme R, van Dijk C, IJpma F, Eygendaal D. Are Eponyms Used Correctly or Not? A Literature Review with a Focus on Shoulder and Elbow Surgery. Evid Based Med. 2016;21(5):163-71. <a href="https://doi.org/10.1136/ebmed-2016-110453">doi:10.1136/ebmed-2016-110453</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27565943">Pubmed</a>
7. Bankart A. Recurrent or Habitual Dislocation of the Shoulder-Joint. BMJ. 1923;2(3285):1132-3. <a href="https://doi.org/10.1136/bmj.2.3285.1132">doi:10.1136/bmj.2.3285.1132</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20771383">Pubmed</a>

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