Bankart Repair vs. Latarjet Procedure: How Surgeons Choose

Both procedures are used to treat shoulder instability. The arthroscopic Bankart repair restores the torn labrum and tightens the capsule. The open Latarjet procedure transfers a piece of bone to rebuild the front of the glenoid socket. Which one is appropriate depends primarily on one factor: the amount of glenoid bone loss. Below roughly 15%, Bankart repair is effective for the right patient. At or above that threshold, particularly in athletes and patients with recurrent anterior shoulder dislocation, the Latarjet procedure significantly outperforms Bankart repair in preventing postoperative instability.

Choosing the wrong procedure for the wrong patient leads to recurrent shoulder instability, revision surgery, and worse outcomes. The decision for Bankart repair vs. Latarjet procedure should be made by a shoulder dislocation surgeon like Steven J. Thornton, MD, who has specific experience in anterior shoulder stabilization surgery.

Understanding Anterior Shoulder Instability

The glenohumeral joint is the most mobile and most commonly dislocated joint in the human body. Anterior shoulder instability, where the humeral head shifts forward out of the glenoid socket, accounts for the large majority of shoulder instability cases. It typically begins with a traumatic anterior shoulder instability, from a fall, contact sports injury, or forced external rotation.

When an anterior shoulder dislocation occurs, it commonly tears the anterior inferior labrum away from the glenoid rim, a lesion known as a Bankart lesion. The joint capsule is also stretched or torn. In many cases, particularly after repeated anterior dislocations, the glenoid rim itself sustains bone loss as fragments break off with each event. On the humeral side, an engaging Hill-Sachs lesion, a compression fracture on the back of the humeral head, may develop and contribute to ongoing instability by catching on the glenoid rim during shoulder movement.

The result is chronic anterior shoulder instability that does not resolve without surgical intervention. Both the Bankart repair and the Latarjet procedure address this problem, but through fundamentally different mechanisms.

What Is Arthroscopic Bankart Repair?

Arthroscopic Bankart repair is the most commonly performed procedure for anterior glenohumeral instability. The surgery is performed arthroscopically, through small incisions with a camera and instruments, making it a minimally invasive option with a relatively faster initial recovery compared to open procedures.

The goal of isolated arthroscopic Bankart repair is to reattach the torn labrum back to the glenoid rim and tighten the stretched capsule. Suture anchors are placed into the bone of the glenoid, and the labrum is secured back to its anatomic position, restoring the soft tissue bumper that helps keep the humeral head centered in the socket.

Arthroscopic Bankart repair produces excellent clinical outcomes and patient-reported outcomes in the right candidates. Systematic review and meta-analysis data consistently support its effectiveness in patients with minimal glenoid bone loss, a first-time anterior dislocation or instability event, and lower-demand activity profiles.

The limitation of Bankart repair is well established: it does not address bone loss. When glenoid bone loss is present, the soft tissue repair alone is insufficient to restore anterior shoulder stability. Studies comparing arthroscopic Bankart repair versus open Latarjet in patients with significant bone defects consistently show higher rates of postoperative instability in the Bankart group. In high-demand athletes and young patients and athletic populations, recurrence rates following isolated arthroscopic Bankart repair can be substantially elevated when bone loss is not accounted for.

What Is the Open Latarjet Procedure?

The open Latarjet procedure is the most widely used bone augmentation technique for anterior shoulder instability when glenoid bone loss is a factor. The procedure involves transferring the coracoid process, a bony projection at the front of the shoulder blade, along with its attached conjoint tendon, to the front of the glenoid socket. The transferred bone graft is secured with screws.

The Latarjet procedure works through two distinct mechanisms. First, the bone graft physically extends the glenoid surface and restores the glenoid bone defect, enlarging the socket to prevent the humeral head from slipping over the rim. Second, the conjoint tendon transferred with the coracoid acts as a dynamic sling across the front of the shoulder, providing an active restraint to anterior instability that becomes especially effective when the arm is in positions of external rotation.

These combined effects make the Latarjet procedure significantly more durable than Bankart repair in patients with recurrent anterior instability, engaging Hill-Sachs lesions, and glenoid bone loss above the critical threshold. Systematic review and meta-analysis data show meaningfully lower recurrence rates with Latarjet compared to Bankart repair in high-risk populations, with comparable or superior functional outcomes in patients who are properly selected.

The trade-off is procedural complexity. The open Latarjet procedure requires an open approach, requires a longer recovery, and involves more surgical steps than arthroscopic Bankart. Complication profiles differ as well, with Latarjet carrying specific risks related to the transferred bone graft, screw placement, and the proximity of nearby neurovascular structures. In experienced hands, these risks are manageable. The procedure should be performed by a shoulder surgeon with specific training in anterior shoulder stabilization surgery.

The Role of Glenoid Bone Loss in the Decision

Glenoid bone loss is the single most important variable in choosing between Bankart repair and the Latarjet procedure. The threshold most commonly cited in the literature is approximately 15 to 25 percent of the glenoid surface.

Below that threshold, in cases of subcritical glenoid bone loss, arthroscopic Bankart repair remains an appropriate option, arthroscopic Bankart repair remains an appropriate option for patients who are not high-demand athletes and who do not have a significant engaging Hill-Sachs lesion. Above that threshold, in cases of critical glenoid bone loss, the evidence strongly favors the Latarjet procedure, the evidence strongly favors the Latarjet procedure. The glenoid bone defect cannot be compensated for with soft tissue repair alone. Proceeding with Bankart repair in the setting of significant bone loss is associated with substantially elevated rates of recurrent shoulder dislocation and postoperative instability.

A bony Bankart lesion, where a fragment of bone has avulsed from the glenoid rim along with the labrum, may be able to be repaired in some cases and can factor into this decision. However, when the bone fragment is small, comminuted, or has been resorbed, it does not restore the glenoid adequately, and Latarjet remains the preferred approach.

The engaging Hill-Sachs lesion is a secondary factor. When present alongside glenoid bone loss, it reinforces the indication for Latarjet. The conjoint tendon sling effect of the Latarjet procedure effectively renders most engaging Hill-Sachs lesions non-engaging by blocking the position of external rotation in which the lesion would otherwise catch on the glenoid rim.

Bankart Repair vs. Latarjet Procedure: Side-by-Side Comparison

The table below summarizes the key clinical differences between the two procedures to assist in understanding how surgeons approach this decision.

When Each Procedure Is Chosen

Arthroscopic Bankart Repair Is Typically Chosen When:

• Glenoid bone loss is below approximately 15 percent of the glenoid surface
• The patient has experienced a primary anterior dislocation or limited recurrent instability events
• There is no engaging Hill-Sachs lesion or the lesion is non-engaging
• The patient is not a high-demand contact sport athlete
• A bony Bankart lesion is present and the fragment is large enough and intact enough for anatomic repair
• The patient and surgeon prioritize minimally invasive technique and faster initial recovery

The Open Latarjet Procedure Is Typically Chosen When:

• Glenoid bone loss meets or exceeds 15 to 25 percent of the glenoid surface
• The patient has experienced recurrent anterior shoulder dislocation with multiple instability events
• A significant engaging Hill-Sachs lesion is present
• The patient is a young athlete in high-risk sports such as football, wrestling, rugby, or overhead sports
• Prior arthroscopic Bankart repair has failed and the patient has recurrent instability
• Chronic anterior shoulder instability has resulted in significant soft tissue stretching that makes capsular repair insufficient on its own
• Primary operative treatment is being selected for a high-risk patient where durability is the priority

What the Evidence Shows

The orthopedic literature on this comparison is substantial. Published systematic reviews and meta-analyses comparing arthroscopic Bankart repair versus open Latarjet in patients with recurrent traumatic anterior instability consistently demonstrate lower recurrence rates with Latarjet in high-risk populations. In general and athletic populations with significant bone loss, arthroscopic Bankart repair compared to Latarjet showed meaningfully higher rates of postoperative instability.

Patient-reported outcomes and subjective shoulder value scores are comparable between the two procedures in appropriately selected patients. Functional outcomes following open Latarjet procedure in patients with bone loss are consistently strong. The recurrence and revision burden, however, falls disproportionately on patients who underwent isolated arthroscopic Bankart repair in the setting of bone loss, and specifically on young patients who return to high-demand activity.

The current consensus among shoulder specialists is that procedure selection must be driven by a precise assessment of bone loss, patient demands, and individual risk factors. Applying arthroscopic Bankart repair universally across all anterior instability patients, without accounting for glenoid bone defect and activity level, leads to preventable recurrence and revision surgery.

How Dr. Thornton Approaches This Decision

At the practice of Dr. Steven J. Thornton, MD, every patient presenting with anterior shoulder instability receives a thorough evaluation that includes a detailed physical exam, imaging to quantify glenoid bone loss, and a full review of instability history, activity demands, and treatment goals.

No single procedure is the right answer for every patient. The decision between Bankart repair and the Latarjet procedure is made based on the individual clinical picture, not a default preference. For patients who are appropriate candidates for arthroscopic Bankart repair, the procedure is performed with precision and a focus on complete soft tissue restoration. For patients with glenoid bone loss, recurrent instability, or high-demand athletic profiles, the Latarjet procedure is recommended when it offers a meaningfully better chance at a durable, stable outcome.

Dr. Thornton walks every patient through the reasoning behind the recommendation, explains the expected recovery, and sets clear expectations for return to activity. Surgery is not recommended until conservative treatment options have been appropriately considered. And when shoulder instability surgery is the right path, the procedure chosen is the one most likely to produce a lasting result.

Frequently Asked Questions

Is the Latarjet procedure better than Bankart repair?

Not universally. In patients with minimal glenoid bone loss and lower activity demands, arthroscopic Bankart repair produces excellent outcomes. In patients with significant glenoid bone loss, recurrent instability, or high athletic demands, the Latarjet procedure delivers lower recurrence rates and is generally the preferred choice.

How much bone loss requires Latarjet?

The commonly cited threshold is 15 to 25 percent of the glenoid surface. Below roughly 15 percent, subcritical glenoid bone loss, Bankart repair remains appropriate for suitable candidates. Above that range, critical bone loss, the Latarjet procedure is typically indicated. The exact threshold is one factor among several and must be interpreted in the context of the full clinical picture.

Can Bankart repair fail?

Yes. the Arthroscopic Bankart procedure has higher failure rates in patients with significant glenoid bone loss, engaging Hill-Sachs lesions, and high-demand athletic activity. When Bankart repair fails and recurrent dislocation persists, revision to the Latarjet procedure is often the next step.

Is the Latarjet procedure safe?

The open Latarjet procedure is well established with a strong long-term track record. It carries specific risks related to its open approach and bone transfer technique, but in experienced hands it is a reliable and durable procedure. Functional outcomes and patient reported outcomes are consistently strong in appropriately selected patients.

Will I lose external rotation after Latarjet?

Some patients experience a mild reduction in external rotation following the open Latarjet procedure due to the conjoint tendon sling effect. For most patients undergoing the procedure, it does not significantly impact function or activity. In overhead athletes, this is a consideration that should be discussed with the treating surgeon before a decision is made.

The Bottom Line

Bankart repair and the Latarjet procedure are both effective treatments for anterior shoulder instability. They are not interchangeable. The right procedure depends on glenoid bone loss, instability history, activity demands, and the specific anatomy of each patient’s shoulder.

Getting this decision right the first time matters. Choosing an inadequate procedure for a high-risk patient means a higher probability of recurrent shoulder dislocation, revision surgery, and a longer road back. Choosing an overly aggressive procedure for a straightforward case means nnecessary surgical complexity and recovery demands.

If you are dealing with recurrent anterior shoulder instability and have questions about which surgical approach is right for you, the starting point is a thorough evaluation with a surgeon who has specific experience in anterior shoulder stabilization surgery. Contact Steven J. Thornton, MD now.

Written by:

Dr. Steven J. Thornton, MD is a board-certified orthopedic surgeon and sports medicine specialist serving patients across the Dallas and Fort Worth metroplex. Fellowship-trained at the Hospital for Special Surgery affiliated with Weill Cornell Medicine, Dr. Thornton specializes in minimally invasive shoulder, knee, hip, and elbow procedures. To schedule a consultation, contact the practice today.