Understanding the Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Shoulder Instability: Surgical and Postsurgical Management

Abstract

In adolescents and young adults, instability is a common shoulder pathology with a myriad of coexisting soft tissue and bony lesions. When evaluating a patient for the cause of instability, care must be given to assess for the infrequent lesions, including glenoid avulsion of the glenohumeral ligaments. This case example illustrates key points in the diagnosis, surgical, and postsurgical management of this less common cause of anterior shoulder instability.

Glenoid Avulsion of the Glenohumeral Ligament Repair Through a Single Working Portal

“…Recognition of the GAGL lesion as a cause of posterior shoulder instability is important because the glenohumeral ligaments are crucial in serving as static stabilizers of the shoulder joint. 9 , 10 Proper identification of GAGL lesions is crucial to proper management and surgical planning. Pearls and pitfalls of our technique are presented in Table 1 , and advantages and disadvantages are listed in Table 2 .…”

Evaluation of variations of the glenoid attachment of the inferior glenohumeral ligament by magnetic resonance arthrography

“…In addition, the characterization of the anatomy of the AB-IGHL glenoid attachment by a radiologist with experience in the method proved to be reproducible and reliable. Although reports in the literature state that diagnosing isolated lesions of the IGHL glenoid attachment (known as ALIPSA/GAGL lesions) with MR arthrography is a challenge and that arthroscopy is the method of choice in those cases ( 24 ) , we believe that a better understanding of the IGHL variations and their depiction on MR arthrography can contribute to changing that idea.…”

“…The statistical analysis was performed with the Statistical Analysis System ( 24 ) , version 9.0 (SAS Institute Inc., Cary, NC, USA). We used the chi-square test to determine whether the types of attachment were associated with the presence or absence of glenohumeral dislocation/instability and labral injury.…”

“…Although an isolated lesion of the IGHL glenoid attachment is rare, it is important to recognize it because, when found in arthroscopies of patients with traumatic shoulder instability, it requires fixation, even if the fibrocartilaginous labrum is intact ( 2 , 24 ) . Diagnosing such a lesion with MR arthrography is considered challenging, and some authors argue that the most appropriate arthroscopic approach for diagnosing and assessing the extent of the lesion is the anterior portal ( 24 ) . A better understanding of the anatomy of the IGHL, combined with the recognition of the different patterns of glenoid attachment, improves the diagnostic capacity of MR arthrography.…”