Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review

Longo, Umile Giuseppe; Rizzello, Giacomo; Ciuffreda, Mauro; Locher, Joel; Berton, Alessandra; Salvatore, Giuseppe; Denaro, Vincenzo

doi:10.1016/j.arthro.2016.03.009

Cited by 54 publications

(72 citation statements)

References 28 publications

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“…It has been reported that patients who are managed nonoperatively for HAGL lesions have shoulder instability recurrence rates as high as 90%. 14 Thus, we sought to examine only surgical outcomes for HAGL deformities. Our results corroborate those of a recently conducted smaller systematic review of HAGL lesions by Longo et al 14 In their review, Longo et al reported on a total of 42 HAGL lesions, for which 25 patients underwent operative management.…”

Section: Discussionmentioning

confidence: 99%

“… 14 Thus, we sought to examine only surgical outcomes for HAGL deformities. Our results corroborate those of a recently conducted smaller systematic review of HAGL lesions by Longo et al 14 In their review, Longo et al reported on a total of 42 HAGL lesions, for which 25 patients underwent operative management. Broadened search criteria and a thorough review of the references of included trials allowed this current systematic review to be increasingly inclusive of studies reporting on the surgical management of HAGL lesions, thus allowing our analysis to include a total of 118 patients.…”

Section: Discussionmentioning

confidence: 99%

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Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

Bozzo

Oitment

Thornley

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The inferior glenohumeral ligament, the most important static anterior stabilizer of the shoulder, becomes disrupted in humeral avulsion of the glenohumeral ligament (HAGL) lesions. Unfortunately, HAGL lesions commonly go unrecognized. A missed HAGL during an index operation to treat anterior shoulder instability may lead to persistent instability. Currently, there are no large studies describing the indications for surgical repair or the outcomes of patients with HAGL lesions.Purpose:To search the literature to identify surgical indications for the treatment of HAGL lesions and discuss reported outcomes.Study Design:Systematic review; Level of evidence, 4.Methods:Two reviewers completed a comprehensive literature search of 3 online databases (MEDLINE, EMBASE, and Cochrane Library) from inception until May 25, 2016, using the keywords “humeral avulsion of the glenohumeral ligament” or “HAGL” to generate a broad search. Systematic screening of eligible studies was undertaken in duplicate. Abstracted data were organized in table format, with descriptive statistics presented.Results:After screening, 18 studies comprising 118 patients were found that described surgical intervention and outcomes for HAGL lesions. The mean patient was 22 years (range, 12-50 years), and 82% were male. Sports injuries represented 72% of all HAGL injuries. The main surgical indication was primary anterior instability, followed by pain and failed nonoperative management. Commonly associated injuries in patients with identified HAGL lesions included a Bankart lesion (15%), Hill-Sachs lesions (13%), and glenoid bone loss (7%). Reporting of outcome scores varied among the included studies. Meta-analysis was not possible, but all included studies reported significantly improved postoperative stability and function. There were no demonstrated differences in outcomes for patients treated with open versus arthroscopic surgical techniques. All but 2 patients undergoing operative management for HAGL lesions were able to return to sport at their previous levels; these included Olympians and professional athletes.Conclusion:HAGL lesions typically occur in younger male patients and are often associated with Bankart lesions and bone loss. Open and arthroscopic management techniques are both effective in preventing recurrent instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes—A Systematic Review

Bozzo

Oitment

Thornley

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Research in the setting of shoulder instability is growing, even though several aspects remain unsolved problems. 10,[12][13][14][15][16][17][18][19] Unfortunately, despite great advances in surgical techniques, the quality of the published studies is low, given the difficulty of testing promising recently developed techniques in well-designed trials. The current pace of advances in methods forces us to take stockdto ask where we are going and what we should research next.…”

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confidence: 99%

Editorial Commentary: Unsolved Problems in Shoulder Instability—The Dilemma of Bone Loss!

Longo

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Bone loss in the setting of shoulder instability is an unsolved problem. Procedures restoring bone stock on the glenoid side vary from minimally invasive arthroscopic techniques of arthroscopic bone block procedures to traditional transposition of the coracoid or bone transplant. These techniques are evolving, and several tips and tricks have been optimized to improve outcomes and to reduce the risk of complications, even though the most terrible complication of transposition of the coracoid remains osteoarthritis in the young adult. The major innovation in the past few years has been the use of remplissage. The aim of our surgical procedures is to restore the anatomy as much as possible. Therefore, gentle handling of bone defects on both the humeral and glenoid sides by means of an arthroscopic bone block and combined remplissage seems to be the future of our surgical procedures.

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“…[12][13][14][15][16][17] We note the original scientific article "Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk Population" by Waterman et al 18 from El Paso, Texas, and Boston, Massachusetts, with commentary by Associate Editor Nikhil Verma, 19 whose editorial acumen is impressive and who is well published on the topic of shoulder instability including glenoid reconstruction using bone grafts. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Lastly, we note "Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review" by Longo et al 35 from Rome. Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon, but not rare, cause of shoulder instability, and as the orthopaedic adage goes, we may not have seen a HAGL, but it has seen us.…”

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confidence: 99%

“…Taken in sum, it is clear that shoulder arthroscopic and related surgery has evolved to a point where the most difficult clinical challenges are under investigation, from visualization of the bicipital groove, 1,[36][37][38][39] to massive cuff tear, 4,10,[40][41][42][43][44][45][46] and from revision shoulder stabilization, 9,[47][48][49][50][51][52][53][54][55] to glenoid reconstruction in populations at high risk for shoulder instability, 18,47,51 and the subtle HAGL. 25,35,56,57 And Editorial Commentaries expand the scientific conversation.…”

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confidence: 99%