Understanding the Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Shoulder Instability: Surgical and Postsurgical Management.
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SUBMITTER: O'Reilly OC
PROVIDER: S-EPMC6948128 | biostudies-literature |
REPOSITORIES: biostudies-literature
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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.
| S-EPMC7953040 | biostudies-literature
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.
| S-EPMC4886453 | biostudies-literature
Project description:BackgroundHumeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability.PurposeTo compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions.Study designCross-sectional study; Level of evidence, 3.MethodsPatients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups.ResultsA total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001).ConclusionApproximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
| S-EPMC10612462 | biostudies-literature
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.
| S-EPMC6823750 | biostudies-literature
Project description:ObjectivesTo theoretically confirm that the glenohumeral ligament (GHL), specifically the inferior glenohumeral ligament (IGHL), plays an important role in posterior shoulder stability in different postures, and to provide reference for clinical diagnosis and treatment of posterior shoulder instability (PSI).Materials and methodsIn this retrospective study, bone-ligament-bone models were established in 15 fresh adult shoulder joint specimens and selective cutting was performed for analysis. The humeral head was loaded posteriorly at a central pressure of 22N using the INSTRON8874 biomechanical testing system and the load-displacement curve was plotted. The posterior displacement of the humeral head was measured after continuous cutting of the following structures: (1) complete; (2) superior glenohumeral ligament (SGHL); (3) SGHL + middle glenohumeral ligament (MGHL); (4) SGHL + MGHL + IGHL; (5) MGHL; (6) MGHL + IGHL; (7) anterior-bundle IGHL (IGHL-AB); (8) posterior-bundle IGHL (IGHL-PB); (9) IGHL. The results obtained were analyzed using the SPSS10.0 statistical software.ResultsFavorable posterior stability of the complete bone-ligament-bone model was observed, with an average displacement of 11.32±3.89 mm. The displacement of SGHL and SGHL + MGHL groups was not significantly increased compared with that in the complete group (P>0.05). After cutting of SGHL + MGHL + IGHL, the posterior displacement of all angles increased (P<0.05), resulting in PSI that was manifested in dislocation or subluxation. There was no obvious increase in posterior displacement after cutting the IGHL-AB (P>0.05). Significantly increased posterior displacement was observed at 45° abduction after cutting the IGHL-PB compared with the complete group, but not at the 90° abduction. The posterior displacement increased obviously at both 45° and 90° abduction when the IGHL was completely cut off (P<0.05).ConclusionsRepairing the IGHL plays a certain role in rebuilding the posterior stability of the shoulder joint. Detecting the function of the IGHL in the abduction and external rotation positions of the shoulder joint has certain significance for diagnosing PSI.
| S-EPMC10086893 | biostudies-literature
Project description:PurposeTo assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group.MethodsThe operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant.ResultsThere were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009.ConclusionPatients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control.Level of evidenceLevel III, retrospective comparative study.
| S-EPMC10497783 | biostudies-literature
Project description:The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. We consider the introduction of this technique will shed light on the surgical treatment of shoulder multidirectional instability.
| S-EPMC7953041 | biostudies-literature
Project description:Anteroinferior glenoid bone loss plays a significant role in recurrent glenohumeral instability. Current surgical strategies to reconstruct the glenoid include coracoid transfer (Bristow-Latarjet procedure), iliac crest autograft, and allograft (osteochondral and iliac crest). These may carry drawbacks of technical difficulty, increased surgical time, neurovascular injury, and nonanatomic reconstruction. We report a technique to manage glenoid bone loss using a pre-shaped, predrilled allograft (Glenojet; Arthrosurface) that matches the native contour of the glenoid. The surgical technique and outcomes are described with an accompanying video and figures.
| S-EPMC5982359 | biostudies-literature
Project description:PurposeTo assess independent predictors of surgery after an emergency department visit for shoulder instability, including patient-related and socioeconomic factors.MethodsPatients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015 to 2018 by International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes (23455, 23460, 23462, 23466, and 29806). A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation, Charlson Comorbidity Index, recurrent dislocation, and primary insurance type.ResultsIn total, 16,721 patients with a shoulder instability diagnosis were included in the analysis and 1,028 (6.1%) went on to have surgery. Patients <18 years old (odds ratio [OR] 8.607, P < .0001), those with recurrent dislocations (OR 2.606, P < .0001), or worker's compensation relative to private insurance (OR 1.318, P = .0492) had increased odds of receiving surgery. Hispanic (OR 0.711, P = .003) and African American (OR 0.63, P < .0001) patients had decreased odds of surgery compared with White patients. Patients with Medicaid (OR 0.582, P < .0001) or self-pay (OR 0.352, P < .0001) insurance had decreased odds of undergoing surgery relative to privately insured patients. Patients with greater levels of social deprivation (OR 0.993, P < .0001) also were associated with decreased odds of surgery.ConclusionsAnterior glenohumeral instability and subsequent stabilization surgery is associated with disparities among patient race, primary insurance, and social deprivation.Clinical relevanceConsidering the relationship between differential care and health disparities, it is critical to define and increase physician awareness of these disparities to help ensure equitable care.
| S-EPMC9402473 | biostudies-literature
Project description:Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency. The following Technical Note provides a diagnostic approach for suspected glenohumeral instability, as well as a detailed description of the congruent-arc Latarjet procedure, performed with a deltoid split, with its postoperative management.
| S-EPMC5495908 | biostudies-literature