Skip to main content
SpringerLink
Log in

Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

There is a paucity of evidence regarding mid- to long-term clinical outcomes of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL). This study investigated clinical outcomes, return to sport and the frequency of associated shoulder lesions.

Methods

Eighteen patients underwent arthroscopic repair of a HAGL lesion between 2008 and 2015. Clinical outcome was evaluated using the Rowe Score, the Quick DASH Score (Q-DASH), the Oxford Shoulder Instability Score (OSIS), the ASES Score and Range of Motion (ROM). Return to sports and associated shoulder lesions were documented.

Results

Sixteen patients agreed to complete the shoulder scores and nine patients were available for clinical examination. Median time to follow-up was 59 months (range 16–104). The median Rowe Score and Q-DASH Score improved significantly from 33 to 85 points and 61 to 7 points, respectively (p = 0.001, p = 0.001). The median OSIS and ASES Score were 20 and 91 points. External rotation was significantly reduced compared to the contralateral side (p = 0.011). One recurrent dislocation was reported. No neurologic or vascular complications after surgery were reported. Five out of the nine patients did not return to sports at the same level. Associated shoulder lesions were found in 89% of the cases.

Conclusion

Arthroscopic repair of a HAGL lesion is a reliable method to restore shoulder stability with good clinical results. However, limitations in external rotation and a reduction in sporting ability may persist at 59 months follow-up. Concomitant lesions are common.

Level of evidence

Case series, level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bach BR, Warren RF, Fronek J (1988) Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J Bone Jt Surg Br 70:274–276

    Article  CAS  Google Scholar 

  2. Beaton DE, Wright JG, Katz JN (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Jt Surg Am 87:1038–1046

    Google Scholar 

  3. Bhatia DN, DasGupta B (2013) Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 21:1603–1609

    Article  PubMed  Google Scholar 

  4. Bhatia DN, de Beer JF (2007) The axillary pouch portal: a new posterior portal for visualization and instrumentation in the inferior glenohumeral recess. Arthroscopy 23:1241 e1241–1245

    Article  PubMed  Google Scholar 

  5. Bokor DJ, Conboy VB, Olson C (1999) Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Jt Surg Br 81:93–96

    Article  CAS  Google Scholar 

  6. Bozzo A, Oitment C, Thornley P, Yan J, Habib A, Hoppe DJ et al (2017) Humeral avulsion of the glenohumeral ligament: indications for surgical treatment and outcomes—a systematic review. Orthop J Sports Med 5:2325967117723329

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bui-Mansfield LT, Banks KP, Taylor DC (2007) Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J Sports Med 35:1960–1966

    Article  PubMed  Google Scholar 

  8. Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ (2002) Humeral avulsions of the glenohumeral ligament: imaging features and a review of the literature. AJR Am J Roentgenol 179:649–655

    Article  PubMed  Google Scholar 

  9. Castagna A, Snyder SJ, Conti M, Borroni M, Massazza G, Garofalo R (2007) Posterior humeral avulsion of the glenohumeral ligament: a clinical review of 9 cases. Arthroscopy 23:809–815

    Article  PubMed  Google Scholar 

  10. Dawson J, Fitzpatrick R, Carr A (1999) The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Jt Surg Br 81:420–426

    Article  CAS  Google Scholar 

  11. Flury M, Rickenbacher D, Audige L (2016) Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion-a case series. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2016.02.030

    Article  PubMed  Google Scholar 

  12. Gagey OJ, Gagey N (2001) The hyperabduction test. J Bone Jt Surg Br 83:69–74

    Article  CAS  Google Scholar 

  13. George MS, Khazzam M, Kuhn JE (2011) Humeral avulsion of glenohumeral ligaments. J Am Acad Orthop Surg 19:127–133

    Article  PubMed  Google Scholar 

  14. Hovelius L, Saeboe M (2009) Neer award 2008: arthropathy after primary anterior shoulder dislocation–223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg 18:339–347

    Article  PubMed  Google Scholar 

  15. Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608

    Article  CAS  Google Scholar 

  16. Kon Y, Shiozaki H, Sugaya H (2005) Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy 21:632

    Article  PubMed  Google Scholar 

  17. Longo UG, Rizzello G, Ciuffreda M, Locher J, Berton A, Salvatore G et al (2016) Humeral avulsion of the glenohumeral ligaments: a systematic review. Arthroscopy 32:1868–1876

    Article  PubMed  Google Scholar 

  18. Nicola T (1942) Anterior dislocation of the shoulder—the role of the articular capsule. J Bone Jt Surg 24:614–616

    Google Scholar 

  19. O’Connell PW, Nuber GW, Mileski RA, Lautenschlager E (1990) The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med 18:579–584

    Article  PubMed  Google Scholar 

  20. Page RS, Bhatia DN (2009) Arthroscopic repair of humeral avulsion of glenohumeral ligament lesion: anterior and posterior techniques. Tech Hand Up Extrem Surg 13:98–103

    Article  PubMed  Google Scholar 

  21. Park KJ, Tamboli M, Nguyen LY, McGarry MH, Lee TQ (2014) A large humeral avulsion of the glenohumeral ligaments decreases stability that can be restored with repair. Clin Orthop Relat Res 472:2372–2379

    Article  PubMed  PubMed Central  Google Scholar 

  22. Provencher MT, McCormick F, LeClere L, Sanchez G, Golijanin P, Anthony S et al (2017) Prospective evaluation of surgical treatment of humeral avulsions of the glenohumeral ligament. Am J Sports Med 45:1134–1140

    Article  PubMed  Google Scholar 

  23. Rhee YG, Cho NS (2007) Anterior shoulder instability with humeral avulsion of the glenohumeral ligament lesion. J Shoulder Elbow Surg 16:188–192

    Article  PubMed  Google Scholar 

  24. Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352

    Article  CAS  PubMed  Google Scholar 

  25. Rothberg DL, Burks RT (2009) Capsular tear in line with the inferior glenohumeral ligament: a cause of anterior glenohumeral instability in 2 patients. Arthroscopy 25:934–936

    Article  PubMed  Google Scholar 

  26. Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Jt Surg Am 63:863–872

    Article  CAS  Google Scholar 

  27. Schippinger G, Vasiu PS, Fankhauser F, Clement HG (2001) HAGL lesion occurring after successful arthroscopic bankart repair. Arthroscopy 17:206–208

    Article  CAS  PubMed  Google Scholar 

  28. Southgate DF, Bokor DJ, Longo UG, Wallace AL, Bull AM (2013) The effect of humeral avulsion of the glenohumeral ligaments and humeral repair site on joint laxity: a biomechanical study. Arthroscopy 29:990–997

    Article  PubMed  Google Scholar 

  29. Warner JJ, Beim GM (1997) Combined bankart and HAGL lesion associated with anterior shoulder instability. Arthroscopy 13:749–752

    Article  CAS  PubMed  Google Scholar 

  30. Wolf EM, Cheng JC, Dickson K (1995) Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy 11:600–607

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Orthopaedic Department, St. John of God Hospital and University Hospital Geelong, Geelong, Australia

    Uli Schmiddem, Adam Watson & Richard Page

  2. Trauma and Orthopaedic Research Unit, Canberra Hospital, Woden, ACT, Australia

    Diana Perriman

  3. Trauma Department, Hanover Medical School, Hanover, Germany

    Emmanouil Liodakis

  4. Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University, Geelong, Australia

    Richard Page

Authors
  1. Uli Schmiddem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adam Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Diana Perriman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanouil Liodakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Page
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

US carried out the medical examination of the patients and drafted the manuscript. EL performed the statistical analysis. AW participated in the design of the study and in recruiting the patients. DP edited the manuscript and gave valuable input. RP conceived the study and participated in its design. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Uli Schmiddem.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Barwon Health Human Research Ethics Committee.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schmiddem, U., Watson, A., Perriman, D. et al. Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport. Knee Surg Sports Traumatol Arthrosc 27, 3246–3253 (2019). https://doi.org/10.1007/s00167-019-05414-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05414-5

Keywords

Search

Navigation