前方Bankart修复术
Patients › Rehabilitation
Rehabilitation protocol after arthroscopic anterior Bankart (labral) repair for anterior shoulder instability — apprehension-position precautions and staged return to sport.
本方案旨在指导您在基兰·希尔帕拉（Kieran Hirpara）医生处接受关节镜下前Bankart修复术后的康复过程。本方案将每个阶段的通俗解释与结构化康复计划相结合，您可以将此计划分享给您的物理治疗师；请在首次就诊时携带此页面或其PDF文件，以确保康复过程协调一致。您的物理治疗师可能会根据您的康复进展调整该计划。
如果您对术后伤口有任何疑虑，请联系诊室。拍摄伤口照片并通过电子邮件发送以供审查通常会有所帮助。
预期情况
Bankart修复术将撕裂的软骨边缘（盂唇）和松弛的关节囊重新固定于关节盂的前方，适用于肩关节向前脱位或半脱位后。该修复属于软组织修复，如同肌腱愈合一样，需要时间牢固地重新长入骨骼：大约需要十二周才能达到可靠的强度。整个康复计划均围绕保护这一愈合过程而制定。
最重要的原则是早期保护肩关节前方，限制手臂的外旋角度。手臂外旋（尤其是手臂向侧方抬起时）会直接牵拉前方的修复部位。因此，初期外旋角度较小，随后逐步、谨慎地增加，至大约十二周时达到完全外旋。
康复过程分阶段进行，而非急于求成。首先恢复活动度，然后恢复力量，最后才逐步满足运动及重体力劳动的需求。软组织盂唇修复的愈合速度慢于骨性Latarjet手术，因此本康复时间表刻意保持耐心：大多数患者在达到既定目标后，于术后四至六个月重返对抗性或过顶运动，而非依据固定的日期。
手术过程
您的Bankart修复术采用关节镜（微创）方式进行。通过小切口，将肩关节前方撕裂的盂唇和关节囊使用微型锚钉和缝线重新固定于关节盂边缘，恢复缓冲结构及维持肱骨头在关节盂内稳定的张力。康复治疗的目的是在愈合期间保护该修复部位，随后逐步恢复肩关节的完全活动度、力量及信心。
佩戴您的悬吊带
您将佩戴简单的肩部悬吊带，而非特殊的支具。Hirpara 医生使用保持中立旋转位（前臂置于腹部前方）的简单悬吊带；无需使用外展枕、楔形垫或“枪套式”支具。您的保护来自于悬吊带以及避免手臂处于高风险位置，而非依赖于支具的形状。
- 白天活动时佩戴悬吊带 6 周，特别是在外出或身处他人面前时。
- 您睡觉时不佩戴悬吊带。 它仅用于日间支撑；睡眠时请取下，手臂舒适地垫在枕头上支撑。睡眠时，保持手臂置于身前并贴近身体：不要让手臂向侧面滑落并外旋（即下文所述的位置）。
- 淋浴和进行锻炼时（在您被指导如何操作后）取下悬吊带。只要悬吊带被取下，请保持手臂放松，置于身前并贴近身体侧面。
- 如果肩部肿胀或疼痛，请使用冰敷，尤其是在锻炼后。
佩戴悬吊带时请注意姿势：保持耳朵、肩膀和髋部在一条直线上，避免含胸驼背。
关键注意事项——切勿
- 切勿将手臂置于“举手”或投掷姿势（手臂向侧面抬起并外旋，如同挥手或准备投掷）。这是肩关节脱位的姿势，会直接牵拉前方的修复部位。有些人使用的一个简单指导原则是“始终让手肘保持在视线范围内”：将手臂置于身前。
- 切勿在早期数周内主动将手臂外旋超过以下限制。外旋活动度是分阶段增加的：前几周仅允许少量活动（约20°，远未达到正前方位置），直至约12周时恢复全范围活动。
- 切勿在约6周前依靠自身力量主动活动肩关节：在此之前，请让健侧手臂或拐杖协助完成动作。
- 切勿在早期将手伸至背后、系文胸或把手插在后裤袋中。
- 切勿在6周内通过患侧手臂进行提、推、拉或承重活动。
- 切勿在康复计划后期之前进行俯卧撑、卧推、宽握或飞鸟重量训练、军式（过头）推举或颈后下拉；这些动作均会对肩关节前方产生负荷或牵拉。
- 切勿强行或拉伸至感觉肩关节可能滑脱的姿势；疼痛或不安感是停止活动的信号。
- 切勿在需要佩戴悬吊带期间（6周）驾驶车辆。
第一阶段：保护期（第0–6周）
前六周的核心目标只有一个：保护肩关节前方的修复部位，使其开始与骨骼愈合。白天需佩戴简易支具以提供支撑，睡眠时脱掉支具（但手臂需保持在前侧，严禁外旋）；通过冰敷控制肿胀，并进行轻柔的锻炼，以保持手、腕和肘关节的活动度，同时避免对修复部位施加负荷或牵拉。此阶段尚不允许进行主动的肩关节自主活动；需借助健侧手臂或拐杖来带动患肢，并保持全身完全放松。
- 支具： 白天佩戴保持中立位的简易支具以提供支撑；睡眠时脱掉支具，但手臂需保持在前侧并收拢；进行锻炼和卫生清洁时取下支具。
- 允许的活动： 仅限辅助性和被动活动（禁止依靠肩部自身力量进行活动）。约从第2周开始，进行轻柔的辅助性前屈上举至约 90°（半程），以及仅进行少量（约20°，未达到正前方位置）的辅助性外旋。整个过程中手臂需保持在身体前方；严禁向侧方伸出并外旋。
- 锻炼： 钟摆运动；轻柔的手、腕和肘部活动；握球练习；肩胛骨设定练习；约从第3周开始，在物理治疗师指导下进行轻柔的无痛性肌肉等长收缩练习（将手臂极轻地压向墙壁或另一只手并保持，不旋转手臂，暂不进行内旋或外旋）；约从第2周开始，若物理治疗师指示，可进行严格控制在设定范围内的有限范围辅助性外旋。
进入下一阶段的条件： 疼痛已缓解并通过简单止痛药得到控制（约3/10分或更低）；已完成六周的支具保护；伤口已愈合且无异常迹象；能在限制范围内耐受轻柔的辅助性活动，且无肩关节不稳或脱位感；且无修复部位过度受力的迹象。
第二阶段：恢复活动与旋转（第6–12周）
此时已不再使用吊带，重点在于恢复活动度，而非力量。您从辅助活动过渡到自主活动，并且重要的是，外旋活动度将逐步增加：在此阶段早期约为30–45°，到第12周左右达到完全。这一过程分步进行，绝不强行操作，因为前方的修复仍在成熟中。随着活动度的改善，将加入轻度肌肉激活（等长）训练。
- 吊带： 已停用。
- 允许的活动： 从辅助活动逐步过渡到自主活动。前屈活动逐渐进展至完全过头。 外旋活动分阶段推进： 此阶段早期约为30–45°，随后逐步增加，到第12周左右达到完全。在此阶段后期，轻柔地重新引入背后活动。
- 练习： 仰卧位辅助前屈；坐位桌面滑动；轻柔的等长（按压并保持）外旋、内旋及手臂侧平举训练；肩部后方的交叉臂拉伸。
进入下一阶段的指征： 您能够自主将手臂前举至接近完全高度，且控制良好（无耸肩或肩胛骨代偿性上提）；外旋活动度已进展至完全或接近完全，且无不适；轻柔的等长训练后无疼痛加重；且在日常活动中无肩关节不稳或脱位感。
第三阶段：强化训练（第12–16周）
到第12周时，修复组织已足够坚固，可以开始正式的强化训练，重点从恢复活动度转向重建力量、耐力和控制力。此时开始使用轻阻力带和轻重量进行抗阻训练：高重复次数，低负荷。用于稳定肩关节的肩袖肌群在各个方向上进行强化，其中外旋方向需谨慎逐步增加，因为这是修复组织最敏感的方向。始终保持动作受控且无痛。
- 支具： 无需佩戴；预期可实现全范围活动。
- 练习： 侧卧位外旋（逐步过渡到轻重量）；侧卧位内旋（使用轻重量）；肘部贴于体侧的外旋（使用轻阻力带）；使用拐杖的内旋；肩后侧的睡眠者拉伸。您的物理治疗师还可能加入节律性稳定训练（轻柔的保持-稳定练习，治疗师轻推您的手臂，您进行抵抗），以重新训练肩关节的控制能力。此为手法操作，无图示。
进入下一阶段的条件： 您能够自主完成全范围、无痛的活动，且肩胛骨控制良好；强化训练后无疼痛或肿胀；旋转力量稳步向健侧水平靠拢；以及在日常负重活动中无恐惧感或不稳感。
第四阶段：重返运动与工作（4–6个月）
本阶段是从稳固且受控的肩部状态过渡到应对运动及较重工作需求的桥梁。您需保持已获得的关节活动度，并增强力量、爆发力和耐力，以自信地运用这些功能。重返过程是分阶段的，而非突然进行；对于过顶运动和对抗性运动，采用逐步增加训练量和强度的间歇性计划是重返赛场最安全的方式。
- 支具： 无。
- 锻炼： 渐进式肩袖和肩胛骨强化训练（弹力带划船、肩胛骨下拉）；训练肩部沿自然伸展轨迹运动的对角线弹力带模式，仅在向外旋转完全且舒适时加入过顶旋转模式；随后根据需要进行针对运动和工作的专项体能训练及受控的高速训练。
重返标准： 您的力量至少达到健侧的 85%，且向外旋转与向内旋转的力量平衡良好；您在负重下拥有完全且无痛的活动范围，无不稳感；并通过针对您运动或工作任务的特定测试。重返对抗性或过顶运动通常在4–6个月左右，这基于是否满足上述标准以及Hirpara医生和您的物理治疗师的许可，而非仅依据日历时间。
重返运动与工作
重返运动与工作的标准基于临床指标：无痛、关节活动度完全恢复、力量平衡、无肩关节不稳感，并经 Hirpara 医生和您的物理治疗师共同批准，而非仅依据日历时间。
- 轻度、久坐型工作： 数周内，手臂需加以保护。
- 力量训练： 约 12 周后开始轻度抗阻训练。
- 投掷及过顶运动： 不早于 4 个月，且需经过循序渐进的负荷增加过程。
- 对抗性及冲撞性运动： 通常为 4–6 个月，基于临床指标。
软组织 Bankart 修复术的愈合速度慢于骨性 Latarjet 手术，因此重返时间通常稍晚；保持耐心有助于保护修复效果，并降低肩关节再次脱位的风险。
协议之后
本协议与诊所的一般康复建议并行；请参阅术后疼痛管理和伤口护理。
Evidence & references
Anterior Stabilisation — Arthroscopic Bankart Repair: Rehabilitation Evidence
Topic: Arthroscopic capsulolabral (Bankart) repair for anterior glenohumeral instability. Compiled: 2026-06-16. Sources: local RAG Orthopaedic corpus (154k articles) + published fellowship/PT "standard of care" protocols. Core early precaution: protect the anterior repair -> limit external rotation (ER) (and combined abduction+ER) in the early weeks, because anterior-inferior capsulolabral healing is stressed by ER. This is the mirror image of the posterior protocol.
Consensus phased timeline
The two published academic protocols below are highly concordant. ER limits are given as degrees in the scapular plane / at the side and at 90 deg abduction.
| Phase | Week window | Sling/brace | ROM allowed & restrictions | AROM / strengthening | RTS |
|---|---|---|---|---|---|
| I - Immediate post-surgical / protection | 0-3 wk | Sling at ALL times (neutral rotation, ~30-45 deg abduction per MGH); remove only for shower + elbow/wrist ROM; sleep in sling 6 wk | No shoulder AROM. PROM begins wk 2: flexion <90 deg, ER in scapular plane <20 deg. Avoid abduction+ER (anterior capsule stress); no reaching behind back | Scapular setting, ball squeezes; submaximal isometrics start wk 3 (avoid ER/IR initially) | None |
| II - Protection / PROM | 4-5 wk | Continue sling | PROM progressed: flexion to ~140 deg, ER to 30-45 deg (at side / scapular plane / and at 90 deg abd per MGH), full IR, full abduction in scapular plane | AAROM; submaximal RC isometrics (ER, IR, flexion, abd, ext); periscapular strengthening | None |
| III - Intermediate / AROM | 6-8 wk | Wean / discontinue sling | ER to 50-65 deg scapular plane, ER to ~75 deg at 90 deg abd, flexion to ~160 deg. Begin AROM (gravity-minimised -> resisted). Begin posterior-capsule stretches (cross-arm, sleeper) | Begin isotonic RC + rhythmic stabilisation (closed->open chain). NO push-ups/pec flys (anterior stress) | None |
| IV - Strengthening / transitional | 8-12 (-16) wk | None | Progress ER (BWH: 65 deg at 20 deg abd, 75 deg at 90 deg abd wk 8-10; then all planes to tolerance). Full PROM/AROM by ~12 wk | Progressive RC + periscapular strengthening, PNF diagonals, light resistance until wk 12. Avoid contact sport | None |
| V - Return to activity / strengthening | 12-16 wk | None | Full ROM | Heavier strengthening, Thrower's 10, closed-chain push-up progression. Light golf/tennis (no serve until 4 mo) | Begin sport-specific / interval programs |
| VI - Unrestricted RTS | 4-6 months | None | Full | Throwing/overhead not before 4 months. Plyometrics, interval throwing | Full RTS on criteria + MD clearance |
Active ROM start: ~week 6. Strengthening start: isometrics wk 3; isotonic RC wk 6-8. RTS: sport-specific ~12-16 wk; throwing/overhead >=4 months; full/contact 4-6 months, criterion-based.
RTS criteria (criterion-based, both protocols)
Surgeon clearance; pain-free without instability/apprehension; adequate ROM for task; strength >=85% of uninvolved arm (handheld dynamometry / isokinetic); ER/IR ratio >64%; symmetric scapular mechanics; functional/endurance tests >85% (MGH battery).
Weight-lifting precautions (anterior-specific)
Avoid wide-grip bench press, military press, lat pulls behind the head; "always see your elbows" (avoid the abduction+ER position that re-stresses the anterior repair).
Key controversies & evidence flags
- Immobilisation position - ER vs IR (first-time DISLOCATION, mostly non-operative, but informs surgical positioning debate).
- Basic-science rationale (Itoi): a randomised cadaveric/MRI program showed the anterior labrum is better reduced (less separation/displacement) in external rotation, and that abduction further improves Bankart-lesion reduction (Abd-60ER > Add-ER/Add-IR). Itoi's RCT reported ER immobilisation x3 wk cut recurrence ~46%.
- Meta-analyses split: Hurley et al (JISAKOS 2021) meta-analysis - ER immobilisation reduced recurrence and improved RTP, with higher compliance. Whelan et al (AJSM 2015, meta-analysis of RCTs), Liu et al (Injury 2014) and Vavken et al (JSES 2014) - no significant benefit of ER over IR. Net: genuinely controversial; best-evidence (multiple RCT meta-analyses) does NOT consistently support ER bracing. Most post-Bankart-repair protocols (BWH/MGH above) use a standard neutral-rotation sling, not an ER brace.
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Evidence strength: STRONG but conflicting (multiple RCTs + >=4 meta-analyses, opposite conclusions).
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Accelerated vs conservative post-Bankart rehab. An RCT (NCT03347019, "Accelerated Rehabilitation After Arthroscopic Bankart Repair") exists; broader literature (Kim & Saper systematic review, Arthroscopy SM&R 2020; DeFroda et al, Sports Health 2018) finds wide protocol variability and a lack of high-level evidence to define the optimal pace, especially in adolescents/young adults. Evidence: WEAK / consensus-only.
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Return-to-sport timing & criteria. International consensus (Hurley/Matache, Arthroscopy 2021/2022, Parts I & III) supports criteria-based rather than purely time-based RTS; Ryan (Arthroscopy 2025 editorial) and Kim et al (AJSM 2022 systematic review/meta-analysis) note RTS criteria reduce recurrence but remain hard to validate. Contact/collision athletes: Dickens et al (AJSM 2017, prospective multicentre) - surgical stabilisation gives ~90% successful RTS and far lower recurrence than non-op in contact athletes. Evidence: consensus + good prospective cohort; criteria-based RTS = moderate.
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Bankart vs Latarjet for the same patient (context). Delgado et al (OJSM 2025, matched-pair long-term) and Beletsky et al (Sports Health 2020, protocol comparison) - Latarjet patients return to sport substantially faster (~19.6 wk vs ~32.4 wk for Bankart, p<0.001 in Beletsky) because bony fixation heals faster than soft-tissue labral repair (which needs ~12 wk). Relevant when choosing procedure in contact athletes / bone loss.
CITATIONS
Published rehabilitation protocols (URLs)
- Brigham & Women's Hospital, Dept. of Rehabilitation Services - Arthroscopic Anterior Stabilization (with or without a Bankart Repair) Protocol (rev. 2016): https://www.brighamandwomens.org/assets/bwh/patients-and-families/rehabilitation-services/pdfs/shoulder-arthroscopic-anterior-stabilization-protocol.pdf
- Massachusetts General Brigham Sports Medicine - Rehabilitation Protocol for Anterior Bankart Repair (rev. 10/2021): https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-anterior-bankart.pdf
- BWH - Open Anterior Stabilization (with or without a Bankart) Protocol: https://www.brighamandwomens.org/assets/bwh/patients-and-families/rehabilitation-services/pdfs/shoulder-open-shoulder-anterior-stabilization-protocol.pdf
Local RAG corpus (article / journal / year)
- Marcaccio SE, Kaarre J, Steuer F, et al. Anterior Glenohumeral Instability. Journal of Bone and Joint Surgery. 2024. (3-phase framework; RTS 4-6 mo; criteria-based testing.) [consensus/review]
- Hurley ET, Matache BA, Wong I, et al. Anterior Shoulder Instability Part I - Diagnosis, Nonoperative Management, and Bankart Repair - An International Consensus Statement. Arthroscopy. 2021;38(2). [consensus]
- Matache BA, Hurley ET, Wong I, et al. Anterior Shoulder Instability Part III - Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-up - An International Consensus Statement. Arthroscopy. 2021;38(2). [consensus]
- Whelan DB, Kletke SN, Schemitsch G, Chahal J. Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials. The American Journal of Sports Medicine. 2015. [STRONG - meta-analysis of RCTs; no ER benefit]
- Hurley ET, Fried JW, Alaia MJ, et al. Immobilisation in external rotation after first-time traumatic anterior shoulder instability reduces recurrent instability: a meta-analysis. Journal of ISAKOS. 2021;6(1). [STRONG - meta-analysis; favours ER]
- Itoi E, Kitamura T, Hitachi S, et al. Arm Abduction Provides a Better Reduction of the Bankart Lesion During Immobilization in External Rotation After an Initial Shoulder Dislocation. The American Journal of Sports Medicine. 2015. [basic science / imaging]
- Liu A, Xue X, Chen Y, et al. The external rotation immobilisation does not reduce recurrence rates or improve quality of life after primary anterior shoulder dislocation: A systematic review and meta-analysis. Injury. 2014. [STRONG - meta-analysis; no ER benefit]
- Vavken P, Sadoghi P, Quidde J, et al. Immobilization in internal or external rotation does not change recurrence rates after traumatic anterior shoulder dislocation. Journal of Shoulder and Elbow Surgery. 2014;23(1). [STRONG - meta-analysis]
- Kim K, Saper MG. Postoperative Management Following Arthroscopic Bankart Repair in Adolescents and Young Adults: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2020;2(6). [systematic review - notes protocol variability / weak evidence]
- Kim M, Haratian A, Fathi A, et al. Can We Identify Why Athletes Fail to Return to Sports After Arthroscopic Bankart Repair? A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2022. [systematic review/meta-analysis]
- Ryan PM. Editorial Commentary: Criteria on the Basis of Return to Sport Evaluation After Arthroscopic Bankart Repair. Arthroscopy. 2025;41(8). [expert editorial]
- Dickens JF, Rue J, Cameron KL, et al. Successful Return to Sport After Arthroscopic Shoulder Stabilization Versus Nonoperative Management in Contact Athletes With Anterior Shoulder Instability: A Prospective Multicenter Study. The American Journal of Sports Medicine. 2017;45(11). [prospective cohort - contact athletes]
- Beletsky A, Cancienne JM, Manderle BJ, et al. A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair. Sports Health. 2020. [protocol comparison - Bankart RTS ~32 wk vs Latarjet ~20 wk]
- Bartl C, Schumann K, Paul J, et al. Arthroscopic Capsulolabral Revision Repair for Recurrent Anterior Shoulder Instability. The American Journal of Sports Medicine. 2011;39(3). (ER restricted to 0 deg for 6 wk; flexion/abd limited to 90 deg for 6 wk - example surgical protocol.)
Overall evidence grade for the phased protocol itself: CONSENSUS / institutional standard-of-care (Level V) - no single RCT defines the canonical timeline; the immobilisation-position question is the only part addressed by RCT-level meta-analysis (and is unresolved).
