Bankart Repairs / Stabilisation Surgery Rehabilitation Protocol

The repair usually involves:

1. Reattachment of capsule and labrum to the bone (Bankart Repair)
2. Reduction in the capsule volume by either tightening the capsule inferiorly
   (inferior capsule shift or T-plasty)
3. Bone grafting of the Socket  (Latarjet Procedure) – Coracoid Process with Biceps Tendon  transfer to the anterior part of the Glenoid through a subscapularis split

Guiding Principles of Rehabilitation

Pain control initial early immobilisation to allow fibrosis around Bankart repair and Capsular reconstruction / Bone graft healing regain motion through active movement not passive stretching develop dynamic stability via rotator cuff and proprioceptive re-training a hyperlax  (atraumatic instability) person will tend to stretch out the capsule again quickly therefore may need to be in a sling longer and warned not to stretch above 90º for 1st  6 weeks with active exercises reassurance that long term results will be superior if movement is regained over a longer time frame alongside dynamic control. Generally this operation is performed on fit, young population.

Shoulder Stabilisation – Post op Protocol

Day  1      

• Cryocuff on ward if available
• Rest, analgesia, explanation
• Elbow, wrist and hand exercises

Day 2

• Still in sling / cryocuff
• Neck / thoracic mobility exercises
• Postural awareness including scapula position
• Discharge / rest in sling day and night and outdoors for 6 weeks 2 weeks
• Clinic / review pain control / begin to wean sling at home
• Wound check / stitches
• Scapular stability and positional awareness
• Maintain arm below 90

Shoulder Stabilisation – Post op Protocol / Physiotherapy protocol

No External Rotation past neutral or Elevation arm above 90º 1st 6 weeks post op.

6 weeks - commence phase I-II exercises
(below 90º if hypermobile / atraumatic).

• Continue scapula setting, neck exercises
  • Start rotator cuff strengthening
  • Start weight bearing exercises eg. Wall press ups
  • Safe CV training eg. Bike, running if comfortable (not swimming)
  • Other strength work eg. legs, abdomen

8-12 weeks - commence mobility exercises above 90º

• Increase cuff strengthening
• Proprioception especially rotation -  dissociation
• Progress dynamic stability of cuff and scapula
• Weights as appropriate / general fitness

12-20 weeks

• Cuff training in apprehension positions and overhead
• Additional mobilising to regain ROM via hold and relax
• Sport specific training
• Use open / closed chain exercises according to specific sports

• No contact sports minimum 6 months – at discretion of surgeon and physio
• With early return to collision sports wear an instability brace

Latarjet Procedure patients

Have an X-ray at 6 weeks post surgery to ensure bone graft and screws in satisfactory position and then follow the above protocol