Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability

Wolf, Eugene M.; Cheng, Joseph; Dickson, Kyle

doi:10.1016/0749-8063(95)90139-6

Cited by 292 publications

(160 citation statements)

References 19 publications

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“…1,4,10,11 In addition, instability-related intra-articular pathology may increase the risk of inferior outcomes after initial treatment, including labral tears, glenoid bone loss, Hill-Sachs lesions, capsular injuries such as humeral avulsion of the glenohumeral ligament (HAGL) lesions, anterior labral periosteal sleeve avulsion (ALPSA) lesions, and rotator cuff tears. [10][11][12][14][15][16][17][18] Osseous deficiency has been increasingly recognized as a significant risk factor for compromised outcomes after nonoperative and arthroscopic treatment of shoulder instability. Studies have attempted to delineate a degree of "critical" bone loss that predicts failure of soft-tissue stabilization techniques.…”

mentioning

confidence: 99%

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

McHale

Sánchez

Lavery³

et al. 2017

Arthroscopy Techniques

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Anterior glenohumeral instability is a common clinical entity, particularly among young athletic patient populations. Nonoperative management and arthroscopic treatment of glenohumeral instability have been associated with high rates of recurrence, particularly in the setting of glenohumeral osseous defects. Coracoid transfer, particularly the Latarjet procedure, has become the treatment of choice for recurrent anterior glenohumeral instability in the setting of osseous deficiencies greater than 20% to 30% of the glenoid surface area and may also be considered for the primary treatment of recurrent instability in the high-risk contact athlete, even in the setting of limited osseous deficiency. The following Technical Note provides a diagnostic approach for suspected glenohumeral instability, as well as a detailed description of the congruent-arc Latarjet procedure, performed with a deltoid split, with its postoperative management.

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mentioning

confidence: 99%

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

McHale

Sánchez

Lavery³

et al. 2017

Arthroscopy Techniques

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“…HAGL lesions have become a recognized cause of recurrent shoulder instability, reported in 2% to 9% of patients with shoulder instability [5,17,23,25]. Despite the increasing awareness of the HAGL lesion, it is unknown whether small and large HAGL lesions have similarly destabilizing effects and whether repair of large lesions will result in restoration of stability.…”

Section: Discussionmentioning

confidence: 99%

“…In 1995, Wolf et al [25] reported the occurrence of a HAGL lesion in six of 64 shoulders (9% of patients) undergoing arthroscopy and treatment of anterior shoulder instability. They insisted that, in patients with documented anterior shoulder instability without a demonstrable primary Bankart lesion, a HAGL lesion should be ruled out.…”

Section: Discussionmentioning

confidence: 99%

“…In 1988, Bach et al [2] reported two cases of the HAGL lesion and produced restorative results by repairing the lateral capsule. HAGL lesions have become a recognized cause of recurrent shoulder instability, reported in 2% to 9% of patients with shoulder instability [5,17,23,25]. Recognizing HAGL lesions during shoulder arthroscopy can by difficult [17], which may contribute to the variability in its reported incidence.…”

Section: Introductionmentioning

confidence: 99%

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

Park

Tamboli

Nguyen

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Humeral avulsion of the glenohumeral ligaments (HAGL) has become a recognized cause of recurrent shoulder instability; however, it is unknown whether small and large HAGL lesions have similarly destabilizing effects and if large lesion repair results in restoration of stability.Questions/purposes In a cadaver model, we evaluated the effect of small and large HAGL lesions and large HAGL lesion 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°gleno-humeral 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.

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“…Capsular avulsions can occur on the glenoid side (Bankart lesion) or on the humeral head side referred to as a HAGL lesion (humeral avulsion of the inferior glenohumeral ligament). [21][22][23] Posterior instability occurs less frequently, only accounting for less than 5% of traumatic shoulder dislocations. 24,25 This type of instability is often seen following a traumatic event such as falling onto an outstretched hand or from a pushing mechanism.…”

Section: Direction Of Instabilitymentioning

confidence: 99%

Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability

Wilk

Macrina²,

Reinold³

2012

Shoulder Instability: A Comprehensive Approach

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Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability

Cited by 292 publications

References 19 publications

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

Latarjet Technique for Treatment of Anterior Shoulder Instability With Glenoid Bone Loss

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

Nonoperative rehabilitation for traumatic and atraumatic glenohumeral instability

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