Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion—a case series

Flury, Manuel; Rickenbacher, Dominik; Audigé, Laurent

doi:10.1016/j.jse.2016.02.030

Cited by 14 publications

(18 citation statements)

References 28 publications

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

Navasartian¹,

Hartzler²,

DeBerardino³

et al. 2019

Arthroscopy Techniques

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Humeral avulsion of the glenohumeral ligament (HAGL) can be a difficult problem to treat. HAGL lesions can be particularly challenging to repair when approached arthroscopically. Because of the technical difficulties of HAGL repair, the surgeon must be strategic to successfully address these lesions arthroscopically. The purpose of this article is to propose a surgical technique that can be used in the arthroscopic treatment of HAGL lesions based on their location.

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Section: Discussionmentioning

confidence: 99%

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

Navasartian¹,

Hartzler²,

DeBerardino³

et al. 2019

Arthroscopy Techniques

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show abstract

“…Previous literature has shown the importance of identifying the presence of the HAGL lesion preoperatively, as it represents a harbinger for recurrent instability. 1 Although much literature has reported significantly lower recurrence rates after surgical stabilization of patients with HAGL lesions versus those who underwent nonoperative management, 9,17,23,28 there is a lack of literature comparing such outcomes with controls without HAGL lesions. However, comparably low rates of recurrence were found in the current study between patients in the HAGL group and those in the pair-matched control group.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study

et al. 2022

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Background: Humeral avulsion glenohumeral ligament (HAGL) lesions are often underreported but have been shown to occur in up to 10% of cases of anterior shoulder instability. Purpose: To compare clinical outcomes and recurrence rates of patients with HAGL lesions undergoing open stabilization for anterior shoulder instability versus a pair-matched control. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of all patients who underwent both arthroscopic and open stabilization procedures with a minimum 24-month follow-up was performed. Patients with HAGL lesions were pair-matched in a 1:6 ratio for age, sex, sport, level of preoperative play, and follow-up length with those without HAGL lesions who underwent arthroscopic Bankart repair alone. Return to play (RTP), the level of return, and the timing of return were assessed. In addition, recurrence, visual analog scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether they would undergo the same surgery again were compared. Results: A total of 15 patients with HAGL lesions who underwent shoulder stabilization procedures were included, with a mean age of 21.5 ± 4.1 years and mean follow-up of 53.5 ± 17.4 months, and were pair-matched to 90 patients without HAGL lesions. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SSV, satisfaction) used between the 2 groups (1.6 vs 1.7, P = .86; 83.4 vs 88.0, P = .06; 85.7 vs 87.2, P = .76; and 86.7% vs 94.5%, P = .26, respectively). In addition, there were no significant differences in terms of overall rates, levels, and timing of RTP between the 2 groups (93.3% vs 90.0%, P > .99; 80.0% vs 78.9%, P > .99; and 5.3 ± 2.2 vs 5.9 ± 2.9 months, P = .45, respectively). There was no significant difference in the rates of apprehension, subluxation, and recurrent instability between the HAGL and pair-matched control groups (26.7% vs 26.7%, P > .99; 6.7% vs 3.3%, P = .47; and 13.3% vs 6.7% months, P = .32, respectively). Conclusion: Patients with anterior shoulder instability undergoing surgical stabilization with open HAGL repair demonstrate excellent functional outcomes and high rates of RTP, with low rates of recurrence in the medium term compared with a control group without HAGL lesions who underwent arthroscopic Bankart repair alone.

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“…1 METHODOLOGICAL ASSESSMENT AND RISK OF BIAS Two blind reviewers (CN, CR) analyzed studies according to JBI Clinical appraisal tools for each study type. Eight case reports [6][7][8][9][10][11][12][13] had a mean score of 7.88 out of 8. five case series [14][15][16][17][18] had a mean score of 9.8 out of 10, and the sole retrospective cohort study 19 was scored 11 out of 11. Both reviewers scored each study the same, with no discrepancies.…”

Section: Literature Searchmentioning

confidence: 99%

“…This study reviews 13 studies with level IV evidence that were either case reports [6][7][8][9][10][11][12][13] or case series, [14][15][16][17][18] and one retrospective cohort study with level III evidence. 19 DEMOGRAPHICS A total of 119 patients were identified with 82 males (68.9%) and 37 females (31.3%) with a mean age of 24.08 years in 13 studies with reported means.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

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Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

et al. 2022

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Purpose To provide an updated overview of recent literature regarding the clinical indications, management, and outcomes of humeral avulsions of the glenohumeral ligament (HAGL) lesion. Methods Medline, Cochrane and Embase were systematically searched using keywords “humeral avulsion of the glenohumeral ligament” and others to identify studies reporting on management of HAGL lesions. Studies were double-screened and reviewed by two blinded authors according to selection criteria. Data was systematically extracted on the following topics: demographics, mechanism of injury, indication for treatment, treatment, post-operative complications, associated injuries, and outcomes including clinical outcome scores, clinical evaluations, and return to activity. Results There were 14 studies included that evaluated a total of 119 patients with HAGL lesions. In these studies, 69% of patients were male with a mean age of 24 years. Sports (23.5%) and fitness training (41.2%) were the most common injury mechanisms. Instability was the most common indication for treatment, followed by pain and recurrent dislocations. 85 associated lesions were reported, with non-descript labral tears (34.5%) and Bankart lesions (22.4%) being the most common. Out of patients treated, 117 of 119 patients were treated operatively, with 60 open and 57 arthroscopic procedures. A variety of clinical outcome scores showed postoperative functional shoulder improvement and 97% of patients were able to return to some level of activity. Conclusions HAGL lesions commonly present with associated injuries, necessitating a high clinical awareness of their presentation and management options to prevent undiagnosed lesions that can lead to persistent instability and pain. Surgical management yields good clinical outcomes.

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Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion—a case series

Cited by 14 publications

References 28 publications

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

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

Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study

Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

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