Bankart Repair Combined with Subscapularis Augmentation for Anterior Shoulder Instability: A Review Article

Abstract

Background: Subcritical glenoid bone loss has become an increasingly recognized contributor to failure following isolated soft-tissue stabilization for anterior shoulder instability. Although historically considered insufficient to mandate bony reconstruction, contemporary biomechanical and clinical evidence demonstrates that even modest loss of the anteroinferior glenoid rim significantly compromises joint stability and increases recurrence rates following arthroscopic Bankart repair.

Objective: To review the anatomical configuration and biomechanical function of the subscapularis and the rationale, indications, contraindications, and comparative role of Bankart repair combined with subscapularis augmentation in anterior shoulder instability with subcritical glenoid bone loss.

Conclusion: Subscapularis augmentation enhances Bankart repair by reinforcing dynamic stabilization, reducing dependence on static restraints alone. Clinical evidence suggests that this combined approach lowers recurrence rates in high-risk patients while maintaining satisfactory range of motion and low morbidity. Its role lies in carefully selected patients with preserved or subcritical bone stock, high functional demand, or additional risk factors for recurrence following isolated Bankart repair. Accurate preoperative quantification of bone loss remains fundamental to surgical decision-making.