Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport

Abstract

Purpose There is a paucity of evidence regarding mid-to long-term clinical outcomes of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL). This study investigated clinical outcomes, return to sport and the frequency of associated shoulder lesions. Methods Eighteen patients underwent arthroscopic repair of a HAGL lesion between 2008 and 2015. Clinical outcome was evaluated using the Rowe Score, the Quick DASH Score (Q-DASH), the Oxford Shoulder Instability Score (OSIS), the ASES Score and Range of Motion (ROM). Return to sports and associated shoulder lesions were documented. Results Sixteen patients agreed to complete the shoulder scores and nine patients were available for clinical examination. Median time to follow-up was 59 months (range 16-104). The median Rowe Score and Q-DASH Score improved signiicantly from 33 to 85 points and 61 to 7 points, respectively (p = 0.001, p = 0.001). The median OSIS and ASES Score were 20 and 91 points. External rotation was signiicantly reduced compared to the contralateral side (p = 0.011). One recurrent dislocation was reported. No neurologic or vascular complications after surgery were reported. Five out of the nine patients did not return to sports at the same level. Associated shoulder lesions were found in 89% of the cases. Conclusion Arthroscopic repair of a HAGL lesion is a reliable method to restore shoulder stability with good clinical results. However, limitations in external rotation and a reduction in sporting ability may persist at 59 months follow-up. Concomitant lesions are common. Level of evidence Case series, level IV.

Arthroscopic Repair of Humeral Avulsion of Glenohumeral Ligament Lesions: Outcomes at 2-Year Follow-up

“…Provencher et al 20 reported pain as being the main complaint of patients with HAGL lesions, present in 85% of their patients, whereas shoulder dislocations and subluxations were reported in 11% and 32%, respectively, of their patients. Schmiddem et al 22 reported shoulder dislocations in 67% of their cohort of 18 patients treated surgically for HAGL lesions. One possible explanation for the sensation of instability is the disruption of proprioceptive feedback in the case of a HAGL lesion, as described by Myers et al 16 for additional shoulder instability pathologies.…”

“…Coexisting pathologies are often found with HAGL lesions. 12 In a recently published study, Schmiddem et al 22 reported an 89% rate of additional shoulder pathologies among patients treated for HAGL lesions. The frequently encountered pathologies are Bankart or anterior labroligamentous periosteal sleeve avulsion lesions, Hill-Sachs lesions, and rotator cuff tears, particularly subscapularis.…”

“… 2 , 10 , 21 , 24 As described by the West Point nomenclature, a HAGL lesion may affect the anterior IGHL, the posterior IGHL (reverse HAGL), or both and with or without the avulsion of a bone fragment. 4 In addition, the floating anterior band, as described by Bokor et al, 2 refers to a bipolar detachment of the IGHL 22 where HAGL and Bankart lesions coexist. 6 Hyperabduction and external rotation of the arm have both been suggested as mechanisms of injury that could result in a HAGL lesion, as demonstrated by Nicola 17 in a cadaveric model.…”

Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligaments Based on Location

“…Iatrogenic injury to the axillary nerve with arthroscopic HAGL repair represents the most concerning potential complication versus open surgery. Neurovascular injury does not appear to have been reported as a complication in the published literature on arthroscopic HAGL repair 5, 15, 16, 17. Nevertheless, the axillary nerve has been reported to be approximately 4 to 5 mm from the free lateral edge of the HAGL lesion on preoperative magnetic resonance imaging and during open surgery 18 .…”

Evaluating the effects of arthroscopic Bankart repair and open Latarjet shoulder stabilisation procedures on shoulder joint neuromechanics and function: a single-centre, parallel-arm trial protocol

“…In addition, while arthroscopic repair can restore shoulder stability and function, not all athletes who undergo this procedure return to the same level of sport. 21 While the Latarjet procedure may reduce the risk of recurrent instability and promote return to sport, bone block procedures incur higher complication rates (ie, 7.2%–13.6% vs 0.5%–6.2% for non-bone block procedures) 22 and may also contribute to postoperative osteoarthritis due to impingement on articular cartilage. 23 The Latarjet procedure requires high precision and subtle variations in surgical technique (eg, coracoid bone graft placement and orientation, graft fixation, subscapularis reattachment location) may impact graft strength, the loads experienced at the shoulder and the likelihood of degenerative changes arising.…”