Posterior shoulder instability due to isolated reverse HAGL lesion in a young gymnast: A rare mechanism of injury and surgical technique

Maalouly, Joseph; Aouad, Dany; Ayoubi, Rami; Dib, Nabil; Rassi, Georges El

doi:10.1016/j.tcr.2020.100312

Cited by 7 publications

(19 citation statements)

References 10 publications

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“…1 METHODOLOGICAL ASSESSMENT AND RISK OF BIAS Two blind reviewers (CN, CR) analyzed studies according to JBI Clinical appraisal tools for each study type. Eight case reports [6][7][8][9][10][11][12][13] had a mean score of 7.88 out of 8. five case series [14][15][16][17][18] had a mean score of 9.8 out of 10, and the sole retrospective cohort study 19 was scored 11 out of 11. Both reviewers scored each study the same, with no discrepancies.…”

Section: Literature Searchmentioning

confidence: 99%

“…This study reviews 13 studies with level IV evidence that were either case reports [6][7][8][9][10][11][12][13] or case series, [14][15][16][17][18] and one retrospective cohort study with level III evidence. 19 DEMOGRAPHICS A total of 119 patients were identified with 82 males (68.9%) and 37 females (31.3%) with a mean age of 24.08 years in 13 studies with reported means.…”

Section: Data Extraction and Analysismentioning

confidence: 99%

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Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

et al. 2022

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Purpose To provide an updated overview of recent literature regarding the clinical indications, management, and outcomes of humeral avulsions of the glenohumeral ligament (HAGL) lesion. Methods Medline, Cochrane and Embase were systematically searched using keywords “humeral avulsion of the glenohumeral ligament” and others to identify studies reporting on management of HAGL lesions. Studies were double-screened and reviewed by two blinded authors according to selection criteria. Data was systematically extracted on the following topics: demographics, mechanism of injury, indication for treatment, treatment, post-operative complications, associated injuries, and outcomes including clinical outcome scores, clinical evaluations, and return to activity. Results There were 14 studies included that evaluated a total of 119 patients with HAGL lesions. In these studies, 69% of patients were male with a mean age of 24 years. Sports (23.5%) and fitness training (41.2%) were the most common injury mechanisms. Instability was the most common indication for treatment, followed by pain and recurrent dislocations. 85 associated lesions were reported, with non-descript labral tears (34.5%) and Bankart lesions (22.4%) being the most common. Out of patients treated, 117 of 119 patients were treated operatively, with 60 open and 57 arthroscopic procedures. A variety of clinical outcome scores showed postoperative functional shoulder improvement and 97% of patients were able to return to some level of activity. Conclusions HAGL lesions commonly present with associated injuries, necessitating a high clinical awareness of their presentation and management options to prevent undiagnosed lesions that can lead to persistent instability and pain. Surgical management yields good clinical outcomes.

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Section: Literature Searchmentioning

confidence: 99%

Section: Data Extraction and Analysismentioning

confidence: 99%

Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

et al. 2022

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“…It is the thinnest and weakest part of the glenohumeral joint capsule and variably visualized with MRI. 40 It is most readily visualized with MR arthrography and most commonly torn at its humeral attachment as a reverse humeral avulsion of the glenohumeral ligament (HAGL) lesion [41][42][43] (►Fig. 5).…”

Section: Capsuloligamentous Stabilizersmentioning

confidence: 99%

Imaging Posterior Instability of the Shoulder

Rajeswaran¹,

Basu

Funk

2022

Semin Musculoskelet Radiol

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Posterior instability of the shoulder is much less common than anterior instability with a clinical presentation that is often less obvious, making the diagnosis more challenging and more easily missed. We describe the imaging findings of posterior instability so the radiologist can make the diagnosis and provide a detailed description, enabling the surgeon to make more informed decisions regarding management and surgery.

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“…Many cases report patients who failed initial conservative treatment then underwent further testing and surgical repair 2,3,6,8,[10][11][12] . However, it has been suggested that young athletes be considered for early operative intervention 1,2,5,6 . Humeral avulsion of the posterior glenohumeral ligament (RHAGL) lesions are exceedingly uncommon, and much of the literature consists of case reports and small case series.…”

mentioning

confidence: 99%

“…Most HAGL lesions cause anterior instability, with only 7% of lesions causing posterior instability [1][2][3][4] . These injuries often occur traumatically in young athletes 2,[5][6][7] . Posterior, or reverse, HAGL lesions present nonspecifically rendering them difficult to diagnose.…”

mentioning

confidence: 99%

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

Bouck

Beyer

Miller

2022

JBJS Case Connector

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Case:We present the case of a 21-year-old male, collegiate division I wide receiver, with a humeral avulsion of the posterior glenohumeral ligament (RHAGL) and near-full-thickness supraspinatus tear after falling on his outstretched arm. He returned to full collegiate participation with symptom resolution after arthroscopic repair of each tear.Conclusion:This case report emphasizes the importance of imaging studies in the diagnosis of RHAGL and details a treatment approach that provided an excellent result in a young, active patient. This information will bring attention to these rare injuries and provides reference for providers who encounter patients with similar symptoms or pathology.

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Posterior shoulder instability due to isolated reverse HAGL lesion in a young gymnast: A rare mechanism of injury and surgical technique

Cited by 7 publications

References 10 publications

Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

Indications, management, and outcomes of humeral avulsions of the glenohumeral ligament: a systematic review

Imaging Posterior Instability of the Shoulder

Repair of a Reverse Humeral Avulsion of the Glenohumeral Ligament and a Supraspinatus Tear in a Division I Collegiate Football Player

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