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. 2025 Nov 25;13(11):23259671251391308.
doi: 10.1177/23259671251391308. eCollection 2025 Nov.

A Novel Surgical Treatment for Bankart Lesion in a Thrower's Shoulder: Reconstruction of the Anterior Band of the Inferior Glenohumeral Ligament Restores Shoulder Biomechanics Closer to Preinjury Levels Than Bankart Repair

Teruhisa Mihata  1   2   3 , Min-Shik Chung  1 , Ryan Lew  1 , Ryan Beyer  1 , Michelle H McGarry  1 , Miki Mihata  4 , Teruki Mihata  5 , Thay Q Lee  1
Affiliations

A Novel Surgical Treatment for Bankart Lesion in a Thrower's Shoulder: Reconstruction of the Anterior Band of the Inferior Glenohumeral Ligament Restores Shoulder Biomechanics Closer to Preinjury Levels Than Bankart Repair

Teruhisa Mihata et al. Orthop J Sports Med. .

Abstract

Background: Bankart repair eliminates acquired shoulder laxity in overhead throwing athletes and sometimes results in decreased maximum shoulder external rotation angle and rates of return to play at preinjury levels. The authors developed a novel surgical reconstruction of the anterior band of the inferior glenohumeral ligament (AIGHL) to maintain shoulder laxity for throwing while stabilizing the shoulder joint.

Hypothesis: AIGHL reconstruction would stabilize the shoulder joint while not decreasing maximum external rotation, whereas Bankart repair would decrease maximum external rotation.

Study design: Controlled laboratory study.

Methods: Eight fresh-frozen cadaveric shoulders were tested in a custom shoulder-testing system. Anterior glenohumeral translation, maximum shoulder external rotation, and humeral head location relative to the glenoid were compared among the following conditions: an intact shoulder, a thrower's shoulder model created by stretching the AIGHL, a Bankart lesion, Bankart repair, and AIGHL reconstruction. In AIGHL reconstruction, a fascia lata graft was patched between the detached AIGHL laterally and glenoid medially at maximum shoulder external rotation to maintain the AIGHL's original length.

Results: In the thrower's shoulder, external rotation and anterior translation were significantly increased (intact, 128° and 2.8 mm; thrower's shoulder, 142° and 7.3 mm; P < .05). A Bankart lesion significantly increased anterior translation (8.3 mm) when compared with the intact condition (P < .01). Bankart repair restored anterior translation (3.0 mm) to intact levels. However, maximum shoulder external rotation significantly decreased after Bankart repair (135°) when compared with the thrower's shoulder (P = .01). AIGHL reconstruction restored anterior translation (6.5 mm) to the level of the thrower's shoulder without decreasing the maximum shoulder external rotation (144°). In the simulated late cocking position, the location of the humeral head relative to the glenoid was unchanged, even after Bankart repair or AIGHL reconstruction.

Conclusion: Bankart repair restored anterior translation to intact levels (tighter than in the thrower's shoulder), but AIGHL reconstruction restored it to the level of the thrower's shoulder. Maximum shoulder external rotation was restored to the level of the thrower's shoulder after AIGHL reconstruction, whereas Bankart repair significantly decreased external rotation when compared with the thrower's shoulder.

Clinical relevance: AIGHL reconstruction may be useful for Bankart lesion in overhead throwing athletes to restore anterior stability while maintaining maximum shoulder external rotation.

Keywords: AIGHL; Bankart lesion; Bankart repair; instability; reconstruction; shoulder.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study.

Figures

Figure 1.
Figure 1.
Anterior band of the inferior glenohumeral ligament (AIGHL) reconstruction with a fascia lata graft.
Figure 2.
Figure 2.
Custom shoulder-testing system.
Figure 3.
Figure 3.
Testing conditions: A, Intact shoulder. B, Thrower’s shoulder model created by stretching the anterior band of the inferior glenohumeral ligament (AIGHL). White arrows show the elongated AIGHL. C, Creation of the Bankart lesion. D, Bankart repair. E, Just before fixing the fascia lata graft to the AIGHL for AIGHL reconstruction. F, Completion of AIGHL reconstruction with the fascia lata graft. A, acromion; AI, anterior band of the inferior glenohumeral ligament; C, coracoid; F, fascia lata graft; G, glenoid; H, humeral head.
See this image and copyright information in PMC

References

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