Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability

doi:10.1016/0749-8063(95)90139-6

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 11, Issue 5, October 1995, Pages 600-607

https://doi.org/10.1016/0749-8063(95)90139-6 Get rights and content

Abstract

The avulsion of the glenohumeral ligament labral complex at the glenoid (Bankart lesion), as well as ligamentous laxity are well known causes of anterior shoulder instability. A lesser known entity, the humeral avulsion of glenohumeral ligaments (HAGL), was studied to determine its incidence and its role in anterior glenohumeral instability. Sixty-four shoulders with the diagnosis of anterior instability were prospectively evaluated by arthroscopy for intraarticular pathology, including Bankart, capsular laxity, and HAGL lesions. Six shoulders were found to have HAGL lesions (9.3%), 11 shoulders with generalized capsular laxity (17.2%), and 47 shoulders with Bankart lesions (73.5%). In patients with documented anterior instability without a demonstratable “primary” Bankart lesion, a HAGL lesion should be ruled out. This lesion is readily recognized arthroscopically, and an appropriate repair of this lesion can restore anterior stability to the patient. The pathological anatomy of the HAGL lesion and our treatment of this lesion is discussed.

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Cited by (268)

Arthroscopic Humeral Avulsion of the Glenohumeral Ligament (HAGL) Repair Utilized Accessory Posterior Portal in the Beach-Chair Position
2024, Arthroscopy Techniques
Shoulder instability, often associated with both soft tissue and bone lesions, can result in shoulder pain and dysfunction. To address this, the combined procedure of a Bankart repair in conjunction with humeral avulsion of the glenohumeral ligament (HAGL) repair aims to minimize failure rates in a single procedure. While HAGL repair is imperative for preventing recurrent instability, there remains a lack of consensus on the optimal surgical technique. This Technical Note aims to elucidate a surgical approach for addressing and repairing HAGL lesions using arthroscopy, specifically employing a combined posterior viewing portal and posteroinferior working portal in the beach-chair position.
Arthroscopic Posterior HAGL Repair Using a Direct Transaxillary Portal
2023, Arthroscopy Techniques
Humeral avulsion of the glenohumeral ligament (HAGL lesion) is a challenging problem in surgery for shoulder instability. Open and arthroscopic approaches and techniques have been described to address this issue. Especially posterior HAGL lesions increase the surgical complexity, as open anterior approaches provide limited visibility and access for successful repair. This article describes an alternative technique using an arthroscopic transaxillary approach to deploy the suture anchor with a perpendicular angle to the humeral bone, thus, improving the ability to perfectly position the anchor at the anatomic insertion of the inferior humeral ligament.
Outcomes following arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion: A systematic review
2023, Journal of Clinical Orthopaedics and Trauma
The purpose of this systematic review was to evaluate patient outcomes following arthroscopic surgical management for a humeral avulsion of the glenohumeral ligament (HAGL) lesion.
Based on PRISMA guidelines, two independent reviewers performed a literature search to isolate studies on arthroscopic HAGL repair. The functional outcomes, return to play (RTP), and recurrent instability from each study were extracted and analyzed.
Overall, 7 manuscripts were included with 49 patients. The patient population was 61.4% male with a mean age of 24.8 years (15–42 years), and 41.9 months of follow-up on average (12–104 months). The Rowe score was the most frequently reported outcome measure with a weighted mean of 89. In total, 81.2% of patients reported being able to RTP post-operatively, with 70.5% reported being able to play at an equal or higher level. There was 1 recurrent dislocation (2%).
The current study found successful clinical outcomes following the arthroscopic management of HAGL lesions. Recurrent dislocation requiring revision was rare, with high rates of return to play including those who could return to the same level of play. However, the paucity of evidence does not permit a statement of best-practice to be made.
A Bibliometric Analysis of the Most Cited Research on Humeral Avulsions of the Glenohumeral Ligament: A Paucity of High-Level Evidence
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To identify the 25 most-cited articles on humeral avulsion of the glenohumeral ligament (HAGL) lesions and characterize them based on number of citations, citation density, source journal, year of publication, geographic origin, article type, and level of evidence.
The Science Citation Index Expanded database was queried for all possible publications regarding HAGL lesions. The 25 most-cited articles from 1976 to 2021 relevant to the topic were selected for further analysis. Articles were characterized based on the number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence.
The number of citations for individual articles ranged from 21 to 182 (mean ± standard deviation: 44.72 ± 36.87). Ten countries contributed to the 25 most cited articles, with 14 of the 25 (56%) articles published in the United States. Furthermore, the top 25 cited articles were published in 9 journals, with the majority in Arthroscopy—The Journal of Arthroscopic and Related Surgery (n = 15, 60%). There were 15 (60%) articles classified as “Clinical,” 9 (36%) as “Review/Expert Opinion,” and 1 (4%) as “Basic Science.” All clinical studies met the standard for level IV evidence.
This bibliometric analysis provides a list of the 25 most cited articles related to HAGL lesions, providing a reference of impactful articles for medical educators. The lack of high level of evidence “Clinical” studies demonstrates that higher-quality research is needed to establish guidelines for the treatment and management of HAGL lesions.
A list of the 25 most-cited articles regarding recurrent glenohumeral instability can serve as a comprehensive reference for practitioners, educators, researchers, and orthopaedic trainees.
Glenoid Avulsion of the Glenohumeral Ligament Repair Through a Single Working Portal
2023, Arthroscopy Techniques
Glenoid avulsion of the glenohumeral ligament (GAGL) is a traumatic cause of shoulder instability. GAGL lesions are a rare shoulder pathology most commonly reported as a source of anterior shoulder instability, with no current reports implicating this pathology as a cause of posterior instability. Satisfactory surgical repairs of GAGL lesions with anterior shoulder instability have been well documented; however, this Technical Note highlights the successful repair of a posterior GAGL lesion through a single working portal with suture anchor fixation of the posterior capsule.
Treatment of the ‘The Naked Humeral Head’: Repair of Supraspinatus Avulsion, Subscapularis Tear, and Humeral Avulsion of the Glenohumeral Ligament
2022, Arthroscopy Techniques
A humeral avulsion of the glenohumeral ligament, or HAGL, lesion is a rare yet debilitating shoulder injury, which can lead to recurrent instability, pain, and overall shoulder dysfunction. The diagnosis is often difficult, requiring both high clinical suspicion, as well as identification on magnetic resonance imaging. In patients with an anterior HAGL, repair often requires an open approach. In extremely rare circumstances, the initial traumatic event that causes a HAGL can also cause disruption of the supraspinatus and subscapularis insertions on the humeral head. We have termed this the “naked humeral head”. The purpose of this technical note is to describe our preferred technique to surgically treat the naked humeral head by repairing a supraspinatus avulsion fracture, HAGL lesion, and complete subscapularis tear.

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Original articleHumeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability

Abstract

Oper tech Orthop

Injury

Recurrent dislocation of the shoulder

J Bone Joint Surg Br

Recurrent or habitual dislocation of the shoulder joint

BMJ

The pathology and treatment of recurrent dislocation of the shoulder joint

Br J Surg

Evaluation of the Putti-Platt reconstruction procedure for recurrent dislocation of the shoulder

J Bone Joint Surg Am

Recurrent dislocation of the shoulder

Dynamic electromyographic analysis of the throwing shoulder with glenohumeral instability

J Bone Joint Surg Am

Factors related to recurrences of anterior dislocations of the shoulder

Clin Orthop

The Bankart procedure: A long-term end result

J Bone Joint Surg Am

Recurrent transient subluxation of the shoulder

J Bone Joint Surg Am

Original article
Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability