Successful Arthroscopic Bankart Repair for Recurrent Left Shoulder Dislocation in a 20 Y.O. Male Athlete

PACE Hospitals’ expert Orthopaedic team successfully performed a Diagnostic Arthroscopy with Arthroscopic Bankart Repair and Remplissage on the left shoulder of a 20-year-old male patient diagnosed with anterior shoulder instability associated with Bankart and Hill-Sachs lesions, with the aim of restoring shoulder stability by repairing the torn labrum and addressing the Hill-Sachs defect, preventing recurrent dislocations, relieving pain, and improving functional outcomes.

A 20-year-old male patient, with a body mass index (BMI) of 21, presented to the Orthopaedics Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of pain and instability in the left shoulder for several months. He reported difficulty participating in sports, especially contact sports, due to recurrent shoulder instability.

As a regular contact sports player, he had multiple episodes of anterior shoulder dislocation, resulting in decreased endurance and apprehension during play. The patient had previously undergone conservative treatment, including physiotherapy, but experienced no significant relief of symptoms.

There was no history of other chronic conditions, such as diabetes, hypertension, or liver disease, documented at the time of admission.

On examination, the patient was conscious, coherent and oriented to time, place, and person, and was in normal general condition. There was no pallor, jaundice, lymphadenopathy, clubbing, or cyanosis. Systemic examination was normal. Examination of the left shoulder showed swelling and a positive anterior apprehension test, indicating instability, while distal neurovascular status was intact. Overall, the findings were consistent with left shoulder instability without any other systemic abnormalities.

Following the clinical examination, the Orthopaedics team conducted a comprehensive assessment, including a detailed review of the patient’s medical history and a focused evaluation of the left shoulder.

To confirm the diagnosis and evaluate the extent of the injury, a comprehensive clinical and systemic examination was performed. The patient exhibited swelling and a positive anterior apprehension test in the left shoulder, indicating instability, while distal neurovascular status remained intact, and systemic examination revealed no significant abnormalities.

MRI of the left shoulder was obtained to assess the soft tissue and bony structures. Radiological findings revealed an anterior labral tear from the 3 to 6 o’clock position and a Hill-Sachs lesion near the articular margin. These clinical and radiological findings established the diagnosis of anterior shoulder instability with Bankart and Hill-Sachs lesions of the left shoulder and guided the treatment plan.

Based on the confirmed diagnosis, the patient was advised to undergo Anterior Shoulder Instability Treatment in Hyderabad, India, under the care of the Orthopaedic Department, ensuring restoration of shoulder stability and optimal functional recovery.

After a detailed consultation with Dr. Raghuram, Senior Orthopaedic Consultant, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of recurrent anterior shoulder dislocations, clinical presentation of pain, swelling, and positive anterior apprehension test in the left shoulder, a focused local examination and imaging studies were undertaken to formulate an optimal treatment strategy.

Based on the clinical and radiological findings, which confirmed an anterior labral tear from 3 to 6 o’clock and a Hill-Sachs lesion near the articular margin of the left humeral head, it was determined that diagnostic arthroscopy with arthroscopic Bankart repair and remplissage was identified as the most suitable surgical intervention. This approach aimed to restore shoulder stability, repair the torn labrum, address the Hill-Sachs defect, relieve pain, prevent recurrent dislocations, and optimize functional recovery for sports and daily activities.

The patient and family members were thoroughly counselled regarding the severity of the injury, the necessity of surgery, the surgical procedure, the associated risks, and the expected postoperative recovery and rehabilitation process.

Following the diagnosis, The patient was scheduled to undergo Diagnostic Arthroscopy and Arthroscopic Bankart Repair And Remplissage Procedure in Hyderabad at PACE Hospitals, under the supervision of the expert Orthopaedic Department.

The surgical procedure involved the following steps:

• Patient Positioning and Anesthesia: The patient was positioned in the beach chair position under general anesthesia to provide optimal access and visualization of the left shoulder joint. Standard sterile preparation and draping of the shoulder region were performed to maintain a sterile surgical field throughout the procedure.

• Diagnostic Arthroscopy: A diagnostic arthroscopy of the left shoulder was performed using standard arthroscopic portals. Careful inspection of the glenohumeral joint revealed an anterior labral tear extending from the 3 to 6 o’clock position. A Hill-Sachs lesion was noted near the articular margin of the humeral head. No other intra-articular abnormalities were observed.

• Bankart Repair: The torn anterior labrum was mobilized and released to allow anatomical repositioning. Two all-suture anchors (Syronix) were inserted into the glenoid rim, and the labral tissue was reattached securely. This step restored the tension and stability of the anterior capsulolabral complex, addressing the recurrent instability.

• Remplissage Procedure: The Hill-Sachs defect on the humeral head was addressed using the arthroscopic remplissage technique. The posterior capsule and infraspinatus tendon were secured into the defect using all-suture anchors (Syronix) to “fill in” the lesion, preventing engagement of the humeral head with the glenoid and reducing the risk of future dislocations.

• Closure and Dressing: All arthroscopic portals were sutured using Ethilon 2-0, ensuring proper soft tissue closure. Sterile dressings were applied over the surgical site, and the shoulder was supported in a sling. The procedure was completed without intraoperative complications, and the patient was transferred to recovery for postoperative monitoring.

The patient’s postoperative period was uneventful. The patient was closely monitored for any complications and mobilized as tolerated during the hospital stay. Medications were administered for infection prevention, pain relief, gastric protection, acid suppression, and nutritional support, and wound dressings were performed regularly, remaining clean and dry throughout. The patient remained hemodynamically stable, demonstrated no signs of infection, and was subsequently discharged in stable condition.

Upon discharge, the patient was prescribed medications for infection prevention, pain and inflammation control, gastric protection, and overall support for tissue healing and immunity. These were provided to ensure proper postoperative recovery, promote optimal healing, prevent complications, and support functional restoration of the left shoulder following surgery.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, shoulder pain, and vomiting.

The patient was advised to return for a follow-up visit with the Orthopaedic Doctor in Hyderabad at PACE Hospitals after one week for a wound dressing change.

This case highlights recurrent anterior shoulder instability associated with Bankart and Hill-Sachs lesions that was managed successfully with diagnostic arthroscopy, arthroscopic Bankart repair, and remplissage. The postoperative period was uneventful, with proper mobilization, wound care, and supportive therapy. The patient was discharged in stable condition with instructions for physiotherapy and follow-up care.