Bankart Repair — Arthroscopic Bankart Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Neutral-rotation gunslinger brace for soft-tissue healing x4 wks total (limited removal in safe environments allowed at 4 wks); sling fully discontinued Phase II

Key Restrictions

No ER at 90 deg abduction, no adduction/IR Phase I; ROM limits: flexion <90 deg, ER <20 deg in scapular plane Phase I, progressing to flexion <135 deg, IR <50, ER 30 deg, abduction <115 deg Phase II; avoid forceful ER/extension/horizontal abduction Phase II; no swimming/throwing/overhead serves until Phase III; avoid flat bench press, military press, lat pulldown behind head, and Olympic lifts Phase IV

Timeline & Phases

Phase I (surgery-4 wks): protect arthroscopically-repaired shoulder, cryotherapy 20 min q2h, full active/passive ROM for flexion/abduction/IR to abdomen/ER to 20 deg, activate GH and scapulothoracic stabilizers, gunslinger brace x4 wks, no ER at 90 deg abduction, no adduction/IR, posterior humeral head translation while stretching ER, PROM flexion <90 deg and ER <20 deg in scapular plane, hand gripping, elbow/forearm/wrist ROM, cervical/scapular AROM, axillary nerve desensitization, postural exercises, AAROM/PROM for flexion/abduction/IR/ER to neutral (no terminal stretching), walking/Stairmaster/stationary bike with sling on; progress to Phase II with negative impingement pain/apprehension; Phase II (4-6 wks): ER ROM allowed gradually to prevent loss of fixation, strengthen shoulder/scap stabilizers in protected position (0-60 deg abduction), full sling discontinuation, avoid forceful ER/extension/horizontal abduction, no swimming/throwing/overhead serves, avoid fall-risk activities, PROM flexion <135 deg/IR<50/ER 30 deg in scapular plane/abduction <115 deg/ER to 90 deg with abduction to 30 deg, resisted forward flexion, scapular stabilization exercises (shrugs, rows), AAROM/AROM all planes assessing scapular rhythm, RTC strengthening in protected position, walking/Stairmaster/stationary bike; Phase III (6-12 wks): 5/5 RTC strength at 90 deg, 5/5 peri-scapular strength, no swimming/throwing/overhead serves, avoid fall-risk activities, posterior glides if capsular tightness present, prone flexion/horizontal abduction strengthening, D1/D2 diagonals standing, theraband/light dumbbell IR/ER at 90 deg abduction and rowing, balance board in pushup position with rhythmic stabilization, prone swiss ball walkouts, closed chain stabilization narrow base, rapid alternating supine D2 diagonal movements; Phase IV (12+ wks): 5/5 RTC strength with repetitive testing at 90 deg abduction, demonstrate stability with higher-velocity/change-of-direction movements, gradually progress into provocative exercises (low velocity known patterns first), posterior glides if needed, dumbbell/medicine ball exercises with trunk rotation and RTC strengthening at 90 deg abduction, functional core/hip strength activities, theraband/light dumbbell IR/ER at 90 deg and rowing, higher-velocity/plyometric/rapid theraband drills (below shoulder height two hands, then overhead, then shoulder height one hand), sport-specific biomechanics education for throwing/swimming/overhead sports, avoid flat bench press/military press/lat pulldown behind head/Olympic lifts; return to sport generally acceptable 4-6 months after surgeon/PT clearance

Notes

OSMS Rehabilitation Guidelines; arthroscopic repairs progressed slower than open repairs to prevent loss of fixation (most common failure mode); references Gaunt et al. ASSET consensus guideline (JOSPT 2010), Escamilla et al. (Sports Med 2009), and Wilk & Hooks (Clin Sports Med 2015)