Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: A cause of anterior shoulder instability

Field, Larry D.; Bokor, Desmond J.; Savoie, Felix H.

doi:10.1016/s1058-2746(97)90064-1

Cited by 100 publications

(53 citation statements)

References 12 publications

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“…[3][4][5][6] The strain distribution observed in our study demonstrated that although the amount of tissue recruited increased with increasing external rotation, the overall pattern of strain distribution remained unchanged. This supports the fact that surgeons perform clinical examinations at various external rotation angles and could serve as a foundation for future improvements to treatment and diagnosis protocols.…”

Section: Discussionmentioning

confidence: 51%

“…1,2 Frequently, anterior dislocations result in injury of the anterior band of the inferior glenohumeral ligament and the anterior portion of the axillary pouch near the insertion to the glenoid. [3][4][5][6][7][8] Following conservative treatment, nearly 90% of shoulders in young patients redislocated; 9 therefore, surgical repair is often advocated. However, recurrence rates up to 23% occur after surgical repairs.…”

mentioning

confidence: 99%

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The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation

Moore

Stehle

Rainis

et al. 2008

Journal Orthopaedic Research

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The objective of this study was to determine the strain distribution in the inferior glenohumeral ligament at 08, 308, and 608 of external rotation with an anterior load applied to the joint. Five cadaver shoulders were dissected free of all soft tissue except the glenohumeral capsule and a 7 Â 11 grid of strain markers were affixed to the inferior glenohumeral ligament. The location of these strain markers was then determined for a reference strain configuration and while a 25 N anterior load was applied to simulate a clinical exam for instability. The magnitude and direction of the maximum principal strains were then determined at each joint position. For all specimens, the magnitude of the maximum principal strains were significantly greater for 308 and 608 of external rotation when compared to 08 of external rotation. Furthermore, when comparing 308 to 608 of external rotation, three of the five specimens were significantly different. Additionally, the previously described regions of the inferior glenohumeral ligament could not be identified with a qualitative evaluation of the strain distribution pattern for each specimen at all external rotation angles. This indicates that our current description of the three regions of the inferior glenohumeral ligament does not correspond to its functional role. Additionally, the directions of the maximum principal strains across the inferior glenohumeral ligament became more aligned with one another as external rotation was increased. The complex strain distributions observed indicates that future studies should treat the inferior glenohumeral capsule as a continuous sheet of fibrous tissue. ß

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Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 99%

The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation

Moore

Stehle

Rainis

et al. 2008

Journal Orthopaedic Research

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“…In both series it was noted that Bankart lesions were less common in these patients. Field, Bokor and Savoie, 11 however, have reported six patients with combined HAGL and a Bankart lesion, the 'floating anterior band'.…”

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confidence: 99%

Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament

Bokor¹,

Conboy

Olson

1999

The Journal of Bone and Joint Surgery. British volume

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W e studied retrospectively a consecutive series of 547 shoulders in 529 patients undergoing operation for instability. In 41, the cause of instability was considered to be lateral avulsion of the capsule, including the inferior glenohumeral ligament, from the neck of the humerus, the HAGL lesion. In 35, the lesion was found at first exploration, whereas in six it was noted at revision of a previous failed procedure. In both groups, the patients were older on average than those with instability from other causes. Of the primary cases, in 33 (94.3%) the cause of the first dislocation was a violent injury; six (17.4%) had evidence of damage to the rotator cuff and/or the subscapularis. Only four (11.4%) had a Bankart lesion. In patients undergoing a primary operation in whom the cause of the first dislocation was a violent injury, who did not have a Bankart lesion and had no suggestion of multidirectional laxity, the incidence of HAGL was 39%. The role of anterior capsular structures in preventing dislocation of the glenohumeral joint is well described.

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“…Recent clinical studies have identified capsuloligamentous lesions after initial dislocation of the glenohumeral joint in vivo. Detachment of the glenoid labrum (the Bankart lesion) is common, [39][40][41][42][43] but capsuloligamentous tearing, 39,40,44 and humeral avulsion of the IGHL 44 have also been seen. If injury occurred in vivo at the midsubstance or at the humeral attachment it would probably heal quickly, but possibly in a lengthened state.…”

Section: Discussionmentioning

confidence: 99%

The anterior band of the inferior glenohumeral ligament

McMahon

Dettling

Sandusky

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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Surgical treatment for traumatic, anterior glenohumeral instability requires repair of the anterior band of the inferior glenohumeral ligament, usually at the site of glenoid insertion, often combined with capsuloligamentous plication. In this study, we determined the mechanical properties of this ligament and the precise anatomy of its insertion into the glenoid in fresh-frozen glenohumeral joints of cadavers. Strength was measured by tensile testing of the glenoid-soft-tissue-humerus (G-ST-H) complex. Two other specimens of the complex were frozen in the position of apprehension, serially sectioned perpendicular to the plane containing the anterior and posterior rims of the glenoid, and stained with Toluidine Blue.On tensile testing, eight G-ST-H complexes failed at the site of the glenoid insertion, representing a Bankart lesion, two at the insertion into the humerus, and two at the midsubstance. For those which failed at the glenoid attachment the mean yield load was 491.0 N and the mean ultimate load, 585.0 N. At the glenoid region, stress at yield was 7.8 ± 1.3 MPa and stress at failure, 9.2 ± 1.5 MPa. The permanent deformation, defined as the difference between yield and ultimate deformation, was only 2.3 ± 0.8 mm. The strain at yield was 13.0 ± 0.7% and at failure, 15.4 ± 1.2%; therefore permanent strain was only 2.4 ± 1.1%.Histological examination showed that there were two attachments of the anterior band of the inferior glenohumeral ligament at the site of the glenoid insertion. In one, poorly organised collagen fibres inserted into the labrum. In the other, dense collagen fibres were attached to the front of the neck of the glenoid.J Bone Joint Surg [Br] 1999;81-B:406-13.

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Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: A cause of anterior shoulder instability

Cited by 100 publications

References 12 publications

The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation

The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation

Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament

The anterior band of the inferior glenohumeral ligament

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