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

Navasartian, Douglas; Hartzler, Robert U.; DeBerardino, Thomas M.; Burkhart, Stephen S.

doi:10.1016/j.eats.2019.03.024

Cited by 10 publications

(15 citation statements)

References 16 publications

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“…Surgical repair of RHAGL injuries can be completed through an open or arthroscopic technique. Open repair is performed between the teres minor and infraspinatus using a posterior deltoid splitting approach 8 , which provides superior visualization but is not favored because of risk of injuring the axillary nerve in the quadrangular space 2,6,13 . Arthroscopic repair is preferred because it has shown excellent results and carries a lower risk of neurovascular injury 1 .…”

Section: Discussionmentioning

confidence: 99%

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

Bouck

Beyer

Miller

2022

JBJS Case Connector

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Case:We present the case of a 21-year-old male, collegiate division I wide receiver, with a humeral avulsion of the posterior glenohumeral ligament (RHAGL) and near-full-thickness supraspinatus tear after falling on his outstretched arm. He returned to full collegiate participation with symptom resolution after arthroscopic repair of each tear.Conclusion:This case report emphasizes the importance of imaging studies in the diagnosis of RHAGL and details a treatment approach that provided an excellent result in a young, active patient. This information will bring attention to these rare injuries and provides reference for providers who encounter patients with similar symptoms or pathology.

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Section: Discussionmentioning

confidence: 99%

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

Bouck

Beyer

Miller

2022

JBJS Case Connector

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“…These include open, mini-open, and arthroscopic techniques. 11 , 12 , 19 It is important to recognize that not all HAGL lesions can be addressed with a single surgical technique, and it is therefore important for the treating surgeon to be familiar with each technique. Our mini-open technique has several advantages and disadvantages ( Table 1 ) and it is important to understand these, as well as pearls and pitfalls of the procedure ( Table 2 ), when choosing the most appropriate surgical technique for the patient.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Those that are purely anterior or posterior can be managed arthroscopically, and all-arthroscopic techniques have been described. 11 , 12 However, the all-arthroscopic technique is extremely difficult when the humeral detachment involves the entire inferior glenohumeral ligament, as access to this area on the humerus for reattachment is difficult, and visualization is poor. Moreover, anchor placement along the inferior neck and proximity of the axillary nerve limit exposure along the anterior-inferior pouch and the humeral neck region.…”

mentioning

confidence: 99%

The Original Mini-Open Technique for Repair of Humeral Avulsion of the Glenohumeral Ligament

Grimm

Jimenez

Levy

et al. 2020

Arthroscopy Techniques

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Anterior shoulder dislocations commonly occur in the young, athletic population. The mechanism of dislocation occurs when the shoulder is placed in an abducted, externally rotated position while a forceful anterior moment is applied to the humerus. This position, combined with the force applied, results in an anterior and inferiorly directed dislocation of the humeral head away from the glenoid. Due to the limited stretching capacity of the glenohumeral capsule and associated glenohumeral ligaments, the force of the traumatic dislocation overcomes the tensile strength of these ligaments, resulting in a tear. Although the injury more commonly results in an avulsion of the anteroinferior capsulolabral complex from the glenoid, called a Bankart lesion, other injuries have been described. The anterior inferior glenohumeral ligaments (aIGHLs), may be torn from their humeral attachment, which is referred to as a humeral avulsion of the glenohumeral ligament (HAGL). Although other structures may be injured, the topic of this surgical technique focuses on a mini-open approach for repair of the HAGL lesion.

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“…Surgical management can be performed arthroscopically or with an open approach. The advantages of arthroscopy are reduced surgical morbidity and the ability to repair concomitant pathology 51 . The advantages of open approaches are that they are less technically demanding and allow direct visualization of neurovascular structures.…”

Section: Surgical Managementmentioning

confidence: 99%

“…The knots can be tied within the cannula and placed outside the capsule "by feel." 51 While usually required for reverse Bankart lesions, this portal may not be required for a HAGL repair, which can also be performed through a cannula placed in the traditional posterior camera portal.…”

Section: Anterior Hagl Lesionsmentioning

confidence: 99%

Humeral Avulsion of the Glenohumeral Ligament: Diagnosis and Management

et al. 2022

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The most common type of humeral avulsion of the glenohumeral ligament (HAGL) is a purely ligamentous avulsion involving the anterior inferior glenohumeral ligament (IGHL), but other variants are seen, including posterior lesions and those with an osseous avulsion.» A central lesion between the intact anterior and posterior bands of the IGHL is gaining recognition as a distinct clinical entity.» HAGL lesions are most commonly seen in patients with anterior instability without a Bankart tear or in those with persistent symptoms despite having undergone a Bankart repair.» Magnetic resonance imaging is the most sensitive imaging modality. An arthrogram is helpful with subacute and chronic lesions when the joint is not distended. Arthroscopy is the gold standard for diagnosis.» While some have reported success with nonoperative management, surgical repair with either arthroscopic or open techniques has provided a high rate of successful outcomes; however, the literature is limited to mostly Level-IV and V evidence. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A795).

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

Cited by 10 publications

References 16 publications

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

The Original Mini-Open Technique for Repair of Humeral Avulsion of the Glenohumeral Ligament

Humeral Avulsion of the Glenohumeral Ligament: Diagnosis and Management

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