2015 ISAKOS Biennial Congress ePoster #2304

A Large Humeral Avulsion of the Glenohumeral Ligaments Decreases Stability That Can Be Restored With Repair

Kyoung-Jin Park, MD, PhD, Cheongju, Chungbuk KOREA, REPUBLIC OF
Mallika Tamboli, MS, Irvine, CA UNITED STATES
Lauren Y. Nguyen,, MS, Irvine, CA UNITED STATES
Michelle H. McGarry, MS, Long Beach, CA UNITED STATES
Thay Q. Lee, PhD, Pasadena, CA UNITED STATES
Department of Orthopaedic Surgery, Chungbuk National University, Cheongju, Chungbuk, KOREA

FDA Status Not Applicable

Summary: Anterior large HAGL lesions increase ROM and glenohumeral translation. After large HAGL lesion repair, stability of the shoulder can be restored.

Abstract:

Questions/purposes In a cadaver model, we evaluated the
effect of small and largeHAGLlesions and largeHAGLlesion
repair on glenohumeral ROM, translation, and kinematics.

Methods

We measured rotational ROM, humeral head
translation under load, and humeral head apex position in eight
cadaveric shoulders. Each specimen was tested in 60 glenohumeral
abduction in the scapular and coronal planes under
four conditions: intact, small HAGL lesion (mean ± SD
length, 18 ± 1.8 mm), large HAGL lesion (36.8 ± 3.6 mm),
and after large HAGL lesion repair. For each condition, we
measured maximum internal and external rotation with
1.5 Nm of torque; glenohumeral translation in 90 external
rotation with 15- and 20-N force applied in the anterior, posterior,
superior, and inferior directions; and humeral head apex
position throughout ROM. Repeated-measures ANOVA was
used for statistical analysis.

Results

Small HAGL lesions did not change ROM, translation,
or kinematics from the normal shoulder; however,
these parameters changed with large HAGL lesions. Maximum
external rotation and total ROM increased in
the scapular (13.8 ± 9.4, p\0.001; 19.0 ± 16.5,
p\0.001) and coronal (21.4 ± 10.6, p\0.001; 29.1 ±
22.1, p\0.001) planes. With anterior force, anteriorinferior
translation increased in both planes (mean increase
for both loads and planes: anterior: 9.1 ± 9.5 mm, p\0.01;
inferior, 5.7 ± 6.6 mm, p\0.03). In the coronal plane,
posterior and inferior translation also increased
(4.9 ± 5.4 mm, p\0.01; 7.1 ± 9.9 mm, p\0.03; averaged
for both loads). The humeral head apex shifted
3.7 ± 4.9 mm anterior (p = 0.04) and 2.8 ± 2.6 mm lateral
(p = 0.004) in the scapular plane and 3.7 ± 3.4 mm
superior (p = 0.006) and 4.1 ± 2.6 mm lateral (p\0.001)
in the coronal plane. HAGL lesion repair decreased ROM
and translation in both planes and restored humeral head
position in maximum external rotation.

Conclusions

Anterior large HAGL lesions increase ROM
and glenohumeral translation. After large HAGL lesion
repair, stability of the shoulder can be restored.
Clinical Relevance Surgeons should be aware of the
possibility of HAGL lesions in patients with shoulder
instability, and if large HAGL lesions are diagnosed, surgeons
should consider repairing the lesions.