2017 ISAKOS Biennial Congress ePoster #2009

 

Prospective Evaluation of Surgical Treatment of Humeral Avulsions of the Glenohumeral Ligament (HAGL)

Matthew T. Provencher, MD, Vail, CO UNITED STATES
George Sanchez, Vail, CO UNITED STATES
Frank McCormick, MD, Pompano Beach, FL UNITED STATES
Lance LeClere, MD, San Diego, CA UNITED STATES
Petar Golijanin, MD, MBA, Boston, MA UNITED STATES
Shawn G Anthony, MD, MBA, New York, NY UNITED STATES
Christopher B. Dewing, San Diego, CA UNITED STATES

Naval Medical Center San Diego, San Diego, California, UNITED STATES

FDA Status Not Applicable

Summary

Patients with symptomatic HAGL lesions complain predominantly of shoulder pain and dysfunction, with few chief complaints of recurrent instability complaints.

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Abstract

Background/Purpose: Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss. The purpose of this study is to prospectively collect patients with HAGL lesions followed by retrospective evaluation of the clinical history, examination findings, and surgical outcomes of these patients.

Methods

Over a 6-year period, patients with shoulder dysfunction and a HAGL lesion confirmed via magnetic resonance arthrogram (MRA) were prospectively evaluated with a minimum 2-year follow-up. Patient demographics, presentation, examination and surgical findings were documented. Outcomes of return to activity and SANE and WOSI scores were recorded at final follow-up. Anterior HAGL (aHAGL) lesions were repaired with a partial subscapularis tenotomy approach, while reverse (rHAGL) lesions were repaired arthroscopically.

Results

A total of 27 of 28 patients (96%) completed the study requirements at a mean of 36.2 months (range 24-68 months). There were 12 females (44%) and 15 males (56%) with a mean age of 24.9 years (range 18-34). The chief complaint reported was pain in 23 patients (85%), while only 4 (15%) patients complained primarily of recurrent instability symptoms. There were 14 patients (52%) with aHAGL lesions, 10 patients (37%) with rHAGL lesions, and 3 patients (11%) with combined anterior and posterior HAGL lesions. Ten patients (37%) had concomitant HAGL lesions and labral tears, whereas 17 patients (63%) presented with only a HAGL lesion. The 17 patients (63%) with aHAGL lesions or combined lesions underwent a partial subscapularis tenotomy approach, while the remaining 10 patients (37%) with rHAGL lesions underwent arthroscopic surgical repair. After surgery, outcomes improved from WOSI = 54%, SANE = 50% to WOSI = 88%, SANE = 91% (p<0.01) with no reports in recurrence of instability symptoms at final follow-up.

Conclusions

This study demonstrated that patients with symptomatic HAGL lesions complain predominantly of shoulder pain and dysfunction, with few chief complaints of recurrent instability complaints. After surgery, patients showed predictable return to full activity, improvement in objective and patient-reported outcomes, and satisfaction with treatment outcome.