Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability

Bhatia, Deepak N.; DasGupta, Bibhas

doi:10.1007/s00167-012-2119-y

Cited by 27 publications

(32 citation statements)

References 36 publications

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“… 6 , 26 , 30 A failed nonoperative management course, ranging from 1 to 22 months, was the surgical indication in 4 studies 13 , 20 , 22 , 25 comprising 31 patients. Preoperatively, HAGL lesions were confirmed by either magnetic resonance imaging or magnetic resonance arthrogram in 5 studies 1 , 7 , 12 , 22 , 32 for total of 44 total patients. One author 12 reported that 3 of 6 HAGL lesions were missed on magnetic resonance imaging and confirmed intraoperatively.…”

Section: Resultsmentioning

confidence: 99%

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

Bozzo

Oitment

Thornley

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The inferior glenohumeral ligament, the most important static anterior stabilizer of the shoulder, becomes disrupted in humeral avulsion of the glenohumeral ligament (HAGL) lesions. Unfortunately, HAGL lesions commonly go unrecognized. A missed HAGL during an index operation to treat anterior shoulder instability may lead to persistent instability. Currently, there are no large studies describing the indications for surgical repair or the outcomes of patients with HAGL lesions.Purpose:To search the literature to identify surgical indications for the treatment of HAGL lesions and discuss reported outcomes.Study Design:Systematic review; Level of evidence, 4.Methods:Two reviewers completed a comprehensive literature search of 3 online databases (MEDLINE, EMBASE, and Cochrane Library) from inception until May 25, 2016, using the keywords “humeral avulsion of the glenohumeral ligament” or “HAGL” to generate a broad search. Systematic screening of eligible studies was undertaken in duplicate. Abstracted data were organized in table format, with descriptive statistics presented.Results:After screening, 18 studies comprising 118 patients were found that described surgical intervention and outcomes for HAGL lesions. The mean patient was 22 years (range, 12-50 years), and 82% were male. Sports injuries represented 72% of all HAGL injuries. The main surgical indication was primary anterior instability, followed by pain and failed nonoperative management. Commonly associated injuries in patients with identified HAGL lesions included a Bankart lesion (15%), Hill-Sachs lesions (13%), and glenoid bone loss (7%). Reporting of outcome scores varied among the included studies. Meta-analysis was not possible, but all included studies reported significantly improved postoperative stability and function. There were no demonstrated differences in outcomes for patients treated with open versus arthroscopic surgical techniques. All but 2 patients undergoing operative management for HAGL lesions were able to return to sport at their previous levels; these included Olympians and professional athletes.Conclusion:HAGL lesions typically occur in younger male patients and are often associated with Bankart lesions and bone loss. Open and arthroscopic management techniques are both effective in preventing recurrent instability.

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Section: Resultsmentioning

confidence: 99%

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

Bozzo

Oitment

Thornley

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…In outcomes studies, the contralateral shoulder is frequently used as a marker of ''normal'' strength and range of motion, particularly in the setting of rotator cuff tears and trauma. [2][3][4][5]9,16,25 To our knowledge, no previous studies have used this as a basis for evaluating recovery of subscapularis strength after shoulder arthroplasty. The primary objective of this study was to determine whether subscapularis strength returns to normal after shoulder arthroplasty by comparison to the normal, contralateral side.…”

mentioning

confidence: 99%

The return of subscapularis strength after shoulder arthroplasty

Lapner¹,

Wood²,

Zhang³

et al. 2015

Journal of Shoulder and Elbow Surgery

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“…The authors reported excellent results in a large series of patients using this technique. 7,8 Biomechanical studies have further quantified the role of capsular closure in this procedure. The procedure is performed with special instrumentation (Mitek) that simplifies the procedure and makes it reproducible and safe.…”

Section: Historical Perspectivementioning

confidence: 99%

“…7 Balg and Boileau 12 have described an Instability Severity Index Score, and a score of 6 or greater necessitates a bone grafting procedure like the ALCS. 7 Balg and Boileau 12 have described an Instability Severity Index Score, and a score of 6 or greater necessitates a bone grafting procedure like the ALCS.…”

Section: Indicationsmentioning

confidence: 99%

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Arthroscopic Latarjet and Capsular Shift (ALCS) Procedure

Bhatia

2015

Techniques in Hand &Amp; Upper Extremity Surgery

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Anterior shoulder instability associated with significant bone loss has been described as "bony-instability," and this condition is usually treated with an anterior glenoid bone grafting procedure (Latarjet procedure). The Latarjet procedure involves transfer of the horizontal limb of the coracoid process along with the conjoint tendon to the anterior glenoid rim, and is traditionally performed as an open surgical procedure. Recently, an arthroscopic technique for the Latarjet procedure has been described; the technique necessitates the use of specialized instrumentation and involves excision of the entire anterior capsule to facilitate coracoid fixation. We describe a new "freehand" arthroscopic technique for the Latarjet procedure, and, in addition, a simultaneous capsular shift to further optimize mid and end range stability. This technique eliminates the use of additional instrumentation and can be done using routine arthroscopic instruments. Preliminary experience with this technique suggests that the arthroscopic Latarjet and capsular shift is a technically demanding procedure. Glenohumeral capsule can be preserved, and this should be attempted wherever possible to optimize stability. Additional specialized instrumentation would probably reduce surgical time; however, the procedure can be performed with routine instruments.

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Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability

Abstract: Therapeutic study, Level IV.

Cited by 27 publications

References 36 publications

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

The return of subscapularis strength after shoulder arthroplasty

Arthroscopic Latarjet and Capsular Shift (ALCS) Procedure

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