Bankart repair with anchors — rehabilitation protocol

Start with the discharge summary and operative report

Information is needed on the extent of repair, concomitant procedures, the type and duration of immobilisation, and permitted movement and loading. “Bankart repair with anchors” alone is not enough to set the pace of rehabilitation. Unclear instructions should be clarified with the surgeon.

When should progression stop?

A new sense of the shoulder slipping, sudden pain after a jerk or injury, loss of previously gained function, fever, wound discharge or persistent altered sensation requires assessment. Exercise difficulty must not be increased merely because another week has passed. Suspected redislocation requires urgent medical attention.

PHASE I · WEEKS 0–3

Protecting the repair and moving within the permitted range

Immobilisation: the sling or orthosis prescribed at discharge. The Delphi consensus generally provides for sling protection for approximately three weeks; a longer period prescribed by the surgeon must not be shortened independently.³

These are limits of protected movement during immobilisation described in the BESS synthesis, not values that must be reached in the first session. With the arm at the side, neutral rotation means the forearm points forwards with the elbow bent to 90°. In this phase, the forearm is not moved farther outwards.²

Within the protected range, passive, assisted and permitted active movement may be used after instruction. The hand, wrist and elbow are also exercised. The timing and method of movement follow the instructions for the repair.^{2, 3}

Avoid: combining abduction with external rotation, reaching behind the back, lifting, jerking and supporting body weight through the operated hand. Permitted movement does not mean clearance for loading.

Before progressing: the patient understands the restrictions, performs the taught movements without a clear symptom flare, and the wound and clinical course raise no concerns.

PHASE II · APPROXIMATELY WEEKS 3–6

Gradually increasing movement and controlled activation

Once cleared by the surgeon, sling use is gradually reduced and range of motion increased. Assistance from the other hand and support of the limb help the transition to smooth independent movement. Scapular control and gentle muscle contractions in protected positions are developed.¹

An isometric exercise involves contraction without visible movement, but still loads tissues. The physiotherapist selects the direction and intensity. Resistance exercises through a larger range of motion are not yet introduced. The consensus places this type of strengthening after six weeks, rather than at an arbitrarily earlier time.³

External rotation is advanced particularly carefully. Clearance for greater rotation with the arm at the side does not permit the same movement with the arm abducted. End ranges and movements producing a sense of the humeral head slipping must not be forced.

End-of-phase goal: greater independence in permitted activities and controlled movement within the range set for the repair, without pursuing full mobility at any cost.

PHASE III · APPROXIMATELY WEEKS 6–12

Rebuilding strength, endurance and control

After clinical assessment, movement against light resistance begins, with range and difficulty then increased. The programme includes shoulder rotators, scapular control muscles and coordination of the arm with the trunk. Early examples include rotation with a light band and the elbow close to the body, and scapular exercises without taking the arm far backwards.^{1, 3}

Once weight-bearing through the arm is cleared, small controlled weight shifts are introduced, initially in an easy position such as against a wall. Deep push-ups, fly exercises, dips and sudden overhead movements are not starting exercises. Aggressive anterior capsular stretching is avoided.

End-of-phase goal: a functional, well-controlled range and tolerance of the selected resistance. Strength gains should not come at the expense of movement quality or increasing feelings of instability.

PHASE IV · AFTER WEEK 12

Preparing for work and sport

Exercises increasingly resemble the patient’s actual tasks. Training develops endurance, control during changes of direction and coordination of the shoulder, trunk and lower limbs. Greater range, resistance, speed and unpredictability are introduced gradually rather than all at once.^{1, 4}

Starting this phase does not mean clearance for unrestricted contact sport. Throwing, overhead movement and loads requiring rapid deceleration of the arm need separate clearance. Return to high loads may occur at 4–6 months or later, but this is not a guaranteed date for everyone.

Goal: performing progressively harder work or sport tasks without poorer tolerance of subsequent sessions.

PHASE V · WHEN CRITERIA ARE MET

Return to full activity

The decision combines the course of healing, the surgeon’s assessment, functional examination and the patient’s readiness. Assessment covers the range needed for the activity, rotator strength and endurance, control during support and dynamic movement, and confidence in performing tasks. Testing in abduction with external rotation belongs to late assessment, not to testing a fresh repair.^{3, 4}

Strength should be measured under reproducible conditions, for example with a dynamometer, accounting for arm dominance and the other shoulder’s condition. A single symmetry percentage is not independent clearance to return. A 2025 study found that even healthy volunteers failed some proposed tests and thresholds; results must be interpreted in clinical context.⁵

Return sequence: selected training tasks → partial training → full training → competition or full work duties. Contact level and fall risk are considered separately.