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

ABSTRACT: 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.

SUBMITTER: Grimm NL

PROVIDER: S-EPMC7768049 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description: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.To search the literature to identify surgical indications for the treatment of HAGL lesions and discuss reported outcomes.Systematic review; Level of evidence, 4.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.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.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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The Original Mini-Open Technique for Repair of Humeral Avulsion of the Glenohumeral Ligament.

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