Arthroscopic Repair of Humeral Avulsion of Glenohumeral Ligaments (Hagl) Lesion – Short to Mid-Term Results

Introduction: Diagnosis of Humeral Avulsion of Glenohumeral ligaments (HAGL) lesion is increasing in rates, especially in failed stabilization surgeries or intact labrum. Patients present with a clear clinical history of trauma and instability - or with vague pain and difficulty in using the shoulder. The value of physical exam is limited. Magnetic Resonance Arthrogram may demonstrate contrast extravasation and the "J Sign", however with a low clinical and radiographic correlation. There is limited data regarding the results of

arthroscopic repair of the HAGL lesion.

Design & Methods: A retrospective review of patients who had arthroscopic HAGL repair between the years 2009 and 2016. Results and complications were checked. Study was approved by institutional review board and consent was given.

Results: We identified seven patients who underwent arthroscopic repair of HAGL. Average patients` age was 28 years (15-32), four were females, 85% dominant hand. Mean follow up time was 28 months (12-57). Only in two of the patients the working diagnosis was a HAGL lesion. In all cases was the 30 degrees scope used. One anchor was required in all cases with a second for additional repairs or in case of failure of the first anchor. Concomitant surgical repairs included one Subscapularis repair, one subpectoral LHB tenodesis and one Bankart repair. All but one patient returned to sports at a similar level. One patient suffered from recurrent instability after additional trauma and refused to participate in this study. One patient remained painful and required subsequent LHB. One patient showed major venous bleeding that resolved spontaneously and did not require transfusions.

Conclusions: Arthroscopic repair of HAGL lesions is a feasible operation with good clinical results. Said lesion may be encountered and unplanned for during stabilization surgery and diagnostic arthroscopies. Shoulder surgeons should be familiar with the required portals and associated dangers.