Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 10, pp 1425–1431 | Cite as

Bony Bankart is a positive predictive factor after primary shoulder dislocation

  • Björn SalomonssonEmail author
  • Anders von Heine
  • Mats Dahlborn
  • Hassan Abbaszadegan
  • Susanne Ahlström
  • Nils Dalén
  • Ulf Lillkrona


It would be a great advantage if it were possible to categorise the patients with first time dislocations to an initial treatment with the most beneficial outcome. MRI could be a useful method for finding lesions after shoulder dislocation. Fifty-eight patients with traumatic anterior shoulder dislocation were treated by closed reduction and were examined by MRI after a maximum of 2 weeks. The hemarthrosis or effusion present in the joint after the primary dislocation could be used as a contrast for arthrography to identify the lesions present on MRI. At follow-up more than 8 years later, the MRI findings were compared to the shoulder function, shoulder stability, Rowe score and Western Ontario Shoulder Instability Index (WOSI). Besides the age of the patient being above 30, the MRI findings analysed showed that an isolated fracture of the major tubercle, as well as a bony Bankart lesion are prognostic factors for a good functional result and a stable shoulder after a primary dislocation. The glenoid rim fracture was only detected on plain radiographs in 6 out of 10 findings on MRI. MRI findings of a gleniod rim fracture, equal to a bony Bankart lesion, were found to be a prognostic factor for stability and a good functional outcome.


Primary shoulder dislocation Shoulder instability Shoulder instability MRI Bony Bankart 


  1. 1.
    Antonio GE, Griffith JF, Yu AB, Yung PS, Chan KM, Ahuja AT (2007) First-time shoulder dislocation: high prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging 26:983–991CrossRefPubMedGoogle Scholar
  2. 2.
    Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22:589–594CrossRefPubMedGoogle Scholar
  3. 3.
    Bach BR, Warren RF, Fronek J (1988) Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J Bone Joint Surg Br 70:274–276PubMedGoogle Scholar
  4. 4.
    Baker CL, Uribe JW, Whitman C (1990) Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 18:25–28CrossRefPubMedGoogle Scholar
  5. 5.
    Bankart ASB (1923) Recurrent or habitual dislocation of the shoulder joint. Br Med J 2:1132–1133CrossRefPubMedGoogle Scholar
  6. 6.
    Bigliani LU, Newton PM, Steinmann SP, Connor PM, McLlveen SJ (1998) Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 26:41–45PubMedGoogle Scholar
  7. 7.
    Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC (1992) Tensile properties of the inferior glenohumeral ligament. J Orthop Res 10:187–197CrossRefPubMedGoogle Scholar
  8. 8.
    Habermeyer P, Gleyze P, Rickert M (1999) Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study. J Shoulder Elbow Surg 8:66–74CrossRefPubMedGoogle Scholar
  9. 9.
    Hintermann B, Gachter A (1995) Arthroscopic findings after shoulder dislocation. Am J Sports Med 23:545–551CrossRefPubMedGoogle Scholar
  10. 10.
    Hovelius L (1982) Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 166:127–131Google Scholar
  11. 11.
    Hovelius L (1987) Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis. J Bone Joint Surg Am 69:393–399PubMedGoogle Scholar
  12. 12.
    Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J (1996) Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 78:1677–1684PubMedGoogle Scholar
  13. 13.
    Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind B, Thorling J, Weckstrom J (1983) Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment. J Bone Joint Surg Am 65:343–349PubMedGoogle Scholar
  14. 14.
    Hovelius L, Olofsson A, Sandstrom B, Augustini BG, Krantz L, Fredin H, Tillander B, Skoglund U, Salomonsson B, Nowak J, Sennerby U (2008) Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. J Bone Joint Surg Am 90:945–952CrossRefPubMedGoogle Scholar
  15. 15.
    Ideberg R, Grevsten S, Larsson S (1995) Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand 66:395–397CrossRefPubMedGoogle Scholar
  16. 16.
    Ito H, Takayama A, Shirai Y (2000) Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability. J Shoulder Elbow Surg 9:495–497CrossRefPubMedGoogle Scholar
  17. 17.
    Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, Wakabayashi I, Nozaka K (2007) Immobilization in external rotation after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am 89:2124–2131CrossRefPubMedGoogle Scholar
  18. 18.
    Jakobsen BW, Johannsen HV, Suder P, Sojbjerg JO (2007) Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: a randomized study with 10-year follow-up. Arthroscopy 23:118–123CrossRefPubMedGoogle Scholar
  19. 19.
    Kim KC, Rhee KJ, Shin HD, Kim YM (2007) Estimating the dimensions of the rotator interval with use of magnetic resonance arthrography. J Bone Joint Surg Am 89:2450–2455CrossRefPubMedGoogle Scholar
  20. 20.
    Kirkley A, Griffin S, McLintock H, Ng L (1998) The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 26:764–772PubMedGoogle Scholar
  21. 21.
    Kirkley A, Werstine R, Ratjek A, Griffin S (2005) Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 21:55–63CrossRefPubMedGoogle Scholar
  22. 22.
    Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G (2002) Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 30:116–120PubMedGoogle Scholar
  23. 23.
    Maquieira GJ, Espinosa N, Gerber C, Eid K (2007) Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg Br 89:1347–1351CrossRefPubMedGoogle Scholar
  24. 24.
    Norlin R (1993) Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthroscopy 9:546–549CrossRefPubMedGoogle Scholar
  25. 25.
    Nyffeler RW, Jost B, Pfirrmann CW, Gerber C (2003) Measurement of glenoid version: conventional radiographs versus computed tomography scans. J Shoulder Elbow Surg 12:493–496CrossRefPubMedGoogle Scholar
  26. 26.
    Reeves B (1969) Acute anterior dislocation of the shoulder. Clinical and experimental studies. Ann R Coll Surg Engl 44:255–273PubMedGoogle Scholar
  27. 27.
    Robinson CM, Jenkins PJ, White TO, Ker A, Will E (2008) Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial. J Bone Joint Surg Am 90:708–721CrossRefPubMedGoogle Scholar
  28. 28.
    Rowe CR (1956) Prognosis in dislocations of the shoulder. J Bone Joint Surg 38-A:957–977PubMedGoogle Scholar
  29. 29.
    Rowe CR (1988) Evaluation of the shoulder. In: Rowe CR (ed) The shoulder. Churchill Livingstone, New York, pp 631–637Google Scholar
  30. 30.
    Sachs RA, Lin D, Stone ML, Paxton E, Kuney M (2007) Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted? J Bone Joint Surg Am 89:1665–1674CrossRefPubMedGoogle Scholar
  31. 31.
    Salomonsson B, Ahlstrom S, Dalen N, Lillkrona U (2009) The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation. Acta Orthop 80:233–238CrossRefPubMedGoogle Scholar
  32. 32.
    Speer KP, Deng X, Borrero S, Torzilli PA, Altchek DA, Warren RF (1994) Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg Am 76:1819–1826PubMedGoogle Scholar
  33. 33.
    Suder PA, Frich LH, Hougaard K, Lundorf E, Wulff Jakobsen B (1995) Magnetic resonance imaging evaluation of capsulolabral tears after traumatic primary anterior shoulder dislocation. A prospective comparison with arthroscopy of 25 cases. J Shoulder Elbow Surg 4:419–428CrossRefPubMedGoogle Scholar
  34. 34.
    Suder PA, Mikkelsen JB, Hougaard K, Jensen PE (1995) Reduction of traumatic secondary shoulder dislocations with lidocaine. Arch Orthop Trauma Surg 114:233–236CrossRefPubMedGoogle Scholar
  35. 35.
    Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 25:306–311CrossRefPubMedGoogle Scholar
  36. 36.
    te Slaa RL, Brand R, Marti RK (2003) A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study. J Shoulder Elbow Surg 12:529–534CrossRefPubMedGoogle Scholar
  37. 37.
    te Slaa RL, Wijffels MP, Brand R, Marti RK (2004) The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg Br 86:58–64PubMedGoogle Scholar
  38. 38.
    Urayama M, Itoi E, Sashi R, Minagawa H, Sato K (2003) Capsular elongation in shoulders with recurrent anterior dislocation. Quantitative assessment with magnetic resonance arthrography. Am J Sports Med 31:64–67PubMedGoogle Scholar
  39. 39.
    Valentin A, Winge S, Engstrom B (1998) Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study. Scand J Med Sci Sports 8:405–410CrossRefPubMedGoogle Scholar
  40. 40.
    Vermeiren J, Handelberg F, Casteleyn PP, Opdecam P (1993) The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature. Int Orthop 17:337–341CrossRefPubMedGoogle Scholar
  41. 41.
    Wintzell G, Haglund-Akerlind Y, Tengvar M, Johansson L, Eriksson E (1996) MRI examination of the glenohumeral joint after traumatic primary anterior dislocation. A descriptive evaluation of the acute lesion and at 6-month follow-up. Knee Surg Sports Traumatol Arthrosc 4:232–326CrossRefPubMedGoogle Scholar
  42. 42.
    Zarins B, McMahon MS, Rowe CR (1993) Diagnosis and treatment of traumatic anterior instability of the shoulder. Clin Orthop Relat Res 291:75–84Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Björn Salomonsson
    • 1
    Email author
  • Anders von Heine
    • 2
  • Mats Dahlborn
    • 2
  • Hassan Abbaszadegan
    • 1
  • Susanne Ahlström
    • 1
  • Nils Dalén
    • 1
  • Ulf Lillkrona
    • 1
  1. 1.Division of Orthopaedics, Karolinska InstitutetDanderyd HospitalStockholmSweden
  2. 2.Division of Radiology, Karolinska InstitutetDanderyd HospitalStockholmSweden

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