Rehabilitation Utilizing Blood Flow Restriction Following Surgical Repair of a Bankart Lesion with a Buford Complex in an Elite High School Football Player: A Case Report.

Introduction: Arthroscopic Bankart repair is commonly performed following anterior shoulder instability; however, the presence of a Buford complex introduces unique anatomical and rehabilitative considerations. Evidence guiding postoperative rehabilitation for collision sport athletes with this combined pathology is limited. Additionally, although blood flow restriction (BFR) training has demonstrated benefits for mitigating muscle atrophy during periods of restricted loading, its application in postoperative shoulder rehabilitation remains underexplored. The purpose of this case report is to describe the integration of early-phase BFR within a structured, criterion-based rehabilitation program following arthroscopic Bankart repair in the presence of a Buford complex in a high school collision-sport athlete, and to highlight considerations for return-to-sport testing in this athlete. Case Description: A 17-year-old male high school football linebacker with recurrent anterior shoulder instability underwent arthroscopic Bankart repair with concomitant management of a Buford complex. Physical therapy began 12 days postoperatively and followed a standardized protocol adapted to sport-specific demands. Due to early postoperative restrictions, BFR was incorporated during protective and intermediate phases to support neuromuscular activation and strength development while respecting tissue-healing constraints. Rehabilitation progressed through phased mobility, strengthening, closed-chain loading, and sport-specific activities using objective criteria to guide advancement. Outcome measures included passive and active range of motion (PROM, AROM), shoulder strength via handheld dynamometry, grip strength, girth measurements, patient-reported outcomes (Western Ontario Shoulder Instability Index [WOSI], Shoulder Instability-Return to Sport After Injury [SIRSI]), and functional performance tests (Posterior Shoulder Endurance Test [PSET], Y Balance Test-Upper Quarter [YBT-UQ], Closed Kinetic Chain Upper Extremity Stability Test [CKCUEST]). Outcomes: The athlete completed 18 sessions over 17 weeks. By postoperative Week 17, the athlete demonstrated full, pain-free passive and active shoulder range of motion. Shoulder flexion strength improved from 21.8 lbs at Week 6 to 30.5 lbs at Week 15, and grip strength improved from 92 lbs to 114 lbs. PSET improved from 54.5 seconds to 135.2 seconds, and CKCUEST performance increased from 15 to 24 touches. WOSI scores improved from 38.6% to 25.7%, and SIRSI scores increased from 74.2% to 80.1%. The athlete returned to full football participation 19 weeks after surgery without reported symptoms. Conclusion: This case report illustrates the feasibility of incorporating early-phase BFR within a criterion-based rehabilitation program following Bankart repair in a collision sport athlete with a Buford complex. Further investigation is warranted regarding standardized upper extremity BFR protocols and return-to-sport testing strategies for contact athletes. Level of Evidence: 4.