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Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament Lesion.

ABSTRACT: Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion associated with anterior shoulder instability. Although uncommon, HAGL lesions are a significant contributor to shoulder pain and dysfunction and, if missed, can even be a cause of failed Bankart repair. HAGL lesions should generally be repaired surgically; however, given their low prevalence, there is no consensus on the optimal surgical approach. The purpose of this Technical Note is to describe our preferred surgical technique for the fixation of an HAGL lesion using an all-arthroscopic approach and a knotless suture anchor construct.

SUBMITTER: Fritz EM

PROVIDER: S-EPMC5621980 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament Lesion.

Fritz Erik M EM Pogorzelski Jonas J Hussain Zaamin B ZB Godin Jonathan A JA Millett Peter J PJ

Arthroscopy techniques 20170731 4

Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion associated with anterior shoulder instability. Although uncommon, HAGL lesions are a significant contributor to shoulder pain and dysfunction and, if missed, can even be a cause of failed Bankart repair. HAGL lesions should generally be repaired surgically; however, given their low prevalence, there is no consensus on the optimal surgical approach. The purpose of this Technical Note is to describe our preferred surgical technique f ...[more]

PMID: 29354417

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Concomitant Reverse Hill-Sachs Lesion and Posterior Humeral Avulsion of the Glenohumeral Ligament: Treatment With Fresh Talus Osteochondral Allograft and Arthroscopic Posterior Humeral Avulsion of the Glenohumeral Ligament and Labrum Repair.

Project description:Chronic posterior glenohumeral joint instability can be a challenging clinical entity for patients and surgeons alike. In the setting of a posterior dislocation, a large anterior humeral impaction injury (reverse Hill-Sachs [HS]) may occur, leading to engagement of the humerus with the posterior glenoid bone, especially during internal rotation of the joint. A reverse HS is especially debilitating because of the significant portion of affected humeral head cartilage, and is made worse in the setting of ligamentous disruption such as a posterior humeral avulsion of the glenohumeral ligament (HAGL) lesions. Although several nonanatomic procedures to address these defects have been previously described, recent interest in anatomic reconstructions capable of restoring the cartilage surface of the humeral head has led to the use of bone grafts (autografts and allografts) to restore the articular contour of the humeral head in conjunction with anatomic repair of associated soft tissue injuries. We present our preferred technique for an anatomic repair of a posterior HAGL lesion in combination with reconstruction of an engaging reverse HS lesion using an unmatched hemitalar allograft.

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Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament Lesion With Capsular Plication in the Lateral Decubitus Position.

Project description:Humeral avulsion of the glenohumeral ligament (HAGL) lesions can lead to persistent shoulder instability. While rare, HAGL lesions may present as a concomitant injury following shoulder dislocation events. Traditionally, an open approach has been used to repair the inferior glenohumeral ligament and restore shoulder stability. Modern arthroscopic techniques and instrumentation have permitted a minimally invasive approach for treating HAGL lesions. While technically demanding, arthroscopic repair of HAGL lesions has demonstrated favorable outcomes with less soft-tissue disruption. The following Technical Note describes a safe and effective method for the arthroscopic repair of HAGL lesions. Our technique highlights the use of the lateral decubitus position, a 70° arthroscope, a curved anchor device, and a 90° SutureLasso device.

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Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament for Anterior Shoulder Instability.

Project description:Humeral avulsion of the glenohumeral ligament (HAGL) is a rare cause of anterior shoulder instability. Recurrent instability and anterior shoulder pain could be caused by an unrepaired HAGL; therefore, making the diagnosis is crucial. Only a few articles describe arthroscopic HAGL repair. This uncommon technique uses lateral decubitus arthroscopy and standard Bankart instrumentation. Different methods used to facilitate visualization of the working space as well as anchor placements are described.

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Arthroscopic repair of a posterior bony humeral avulsion of the glenohumeral ligament with associated teres minor avulsion.

Project description:Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a "sheathless" arthroscopic approach with a 70° arthroscope and suture anchor.

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Open Repair of an Anterior Humeral Avulsion of the Glenohumeral Ligament.

Project description:A humeral avulsion of the glenohumeral ligament, or HAGL lesion, is an uncommon yet disabling shoulder injury, which leads to complaints of pain and overall inability to properly use the shoulder from patients. The diagnosis of a HAGL lesion is particularly challenging. To arrive at an accurate diagnosis, the use of a magnetic resonance arthrogram is suggested along with high clinical suspicion. A HAGL lesion may be anterior or posterior. This difference dictates the type of surgical treatment to be undertaken. Although a posterior HAGL lesion is repaired arthroscopically, an anterior HAGL lesion is treated through an open approach. The purpose of this Technical Note is to describe our preferred technique to surgically treat an anterior HAGL lesion through an open approach.

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Project description:Injury to the glenohumeral capsulolabral complex is the critical lesion in anterior shoulder instability. Various injury patterns have been described including the classic Bankart lesion, the bony Bankart lesion, and humeral avulsion of the glenohumeral ligament. A rare injury variant is a glenoid avulsion of the glenohumeral ligament (GAGL lesion). Careful patient setup and surgical technique are required to identify and arthroscopically repair these lesions. We describe a suture anchor-based arthroscopic GAGL repair performed with the patient in the lateral decubitus position through standard anterior and posterior portals and an accessory posterolateral 7-o'clock portal.

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

Project description: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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Treatment of the 'The Naked Humeral Head': Repair of Supraspinatus Avulsion, Subscapularis Tear, and Humeral Avulsion of the Glenohumeral Ligament.

Project description:A humeral avulsion of the glenohumeral ligament, or HAGL, lesion is a rare yet debilitating shoulder injury, which can lead to recurrent instability, pain, and overall shoulder dysfunction. The diagnosis is often difficult, requiring both high clinical suspicion, as well as identification on magnetic resonance imaging. In patients with an anterior HAGL, repair often requires an open approach. In extremely rare circumstances, the initial traumatic event that causes a HAGL can also cause disruption of the supraspinatus and subscapularis insertions on the humeral head. We have termed this the "naked humeral head". The purpose of this technical note is to describe our preferred technique to surgically treat the naked humeral head by repairing a supraspinatus avulsion fracture, HAGL lesion, and complete subscapularis tear.

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Arthroscopic repair of the floating posterior-inferior glenohumeral ligament lesion.

Project description:We present our technique for diagnosis and arthroscopic repair of a floating posterior-inferior glenohumeral ligament avulsion injury. A high degree of suspicion based on the patient's history, along with careful examination, should alert the surgeon to the existence of this lesion. By use of an anterolateral viewing portal and precisely placed posterior working portals, the lesion is repaired through suture anchor fixation to the humeral head and glenoid rim in a carefully sequenced fashion to achieve appropriate tension and restore the anatomy.

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The Original Mini-Open Technique for Repair of Humeral Avulsion of the Glenohumeral Ligament.

Project description:Anterior shoulder dislocations commonly occur in the young, athletic population. The mechanism of dislocation occurs when the shoulder is placed in an abducted, externally rotated position while a forceful anterior moment is applied to the humerus. This position, combined with the force applied, results in an anterior and inferiorly directed dislocation of the humeral head away from the glenoid. Due to the limited stretching capacity of the glenohumeral capsule and associated glenohumeral ligaments, the force of the traumatic dislocation overcomes the tensile strength of these ligaments, resulting in a tear. Although the injury more commonly results in an avulsion of the anteroinferior capsulolabral complex from the glenoid, called a Bankart lesion, other injuries have been described. The anterior inferior glenohumeral ligaments (aIGHLs), may be torn from their humeral attachment, which is referred to as a humeral avulsion of the glenohumeral ligament (HAGL). Although other structures may be injured, the topic of this surgical technique focuses on a mini-open approach for repair of the HAGL lesion.

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