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

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.

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Authors

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.

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Barwon Health Human Research Ethics Committee.

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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

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Keywords

  • Shoulder
  • Instability
  • HAGL lesion
  • Arthroscopy
  • Outcome
  • Sports
  • Concomitant lesions