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

Abstract

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.

Arthroscopic Humeral Avulsion of the Glenohumeral Ligament (HAGL) Repair Utilized Accessory Posterior Portal in the Beach-Chair Position

“…HAGL, although frequently overlooked, emerges as a significant pathology that can be the underlying cause of failed Bankart repair. 9 , 10 , 11 , 12 , 13 , 14 The inferior glenohumeral ligament (IGHL) serves as the primary restraint for the glenohumeral joint in the abduction and external rotation positions, with injury to the anterior band of IGHL identified in 93% of HAGL cases. 13 , 14 While clinical diagnosis is seldom supported by imaging revealing various soft tissue and bone defects, underdiagnosis prevails due to concomitant injuries.…”

Long-term Outcomes After Open Repair of Humeral Avulsion of the Glenohumeral Ligament

“…Only 2 of the 79 patients managed surgically were unable to return to their prior levels of sport. The latest systematic review by Nelson et al 12 in 2022 reported 117 surgically managed HAGL lesions, of which 60 were open procedures. Of these 60 cases, only 2 studies 6 , 15 comprising 32 patients reported clinical outcomes.…”