Adam Dalgleish Orthopaedic Surgeon Adam Dalgleish Orthopaedic Surgeon
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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

 
Mr. Adam Dalgleish
Mr. Adam Dalgleish
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