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Arthroscopy pp 499–509Cite as

Humeral Avulsion of the Glenohumeral Ligament Lesion (aHAGL and pHAGL): Current Concepts in Treatment and Management

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Abstract

Traumatic glenohumeral instability is typically initiated by a specific traumatic event, followed by episodes of instability with a unidirectional pattern [1].

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Abbreviations

abHAGL:

Anterior bony humeral avulsion of the glenohumeral ligament

AC:

Acromioclavicular

aHAGL:

Anterior humeral avulsion of the glenohumeral ligament

aIGHL:

Anterior-inferior glenohumeral ligament

ALPSA:

Anterior labral periosteal sleeve avulsion

faIGHL:

Floating anterior-inferior glenohumeral ligament

fpIGHL:

Floating posterior-inferior glenohumeral ligament

HAGL:

Humeral avulsion of the glenohumeral ligament

IGHL:

Inferior glenohumeral ligament

IGHLC:

Inferior glenohumeral ligament complex

MR:

Magnetic resonance

pbHAGL:

Posterior bony humeral avulsion of the glenohumeral ligament

pHAGL:

Posterior humeral avulsion of the glenohumeral ligament

pIGHL:

Posterior-inferior glenohumeral ligament

ROM:

Range of motion

SLAP:

Superior labral tear from anterior to posterior

References

  1. Meister K. Injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. Am J Sports Med. 2000;28:265–75.

    CAS  PubMed  Google Scholar 

  2. O’Connell PW, Nuber GW, Mileski RA, Lautenschlager E. The contribution of the glenohumeral ligaments to anterior stability of the shoulder joint. Am J Sports Med. 1990;18:579–84.

    Article  PubMed  Google Scholar 

  3. O’Brien SJ, Neves MC, Arnoczky SP, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med. 1990;18:449–56.

    Article  PubMed  Google Scholar 

  4. Plancher KD, Peterson RK, Johnston JC, Luke TA. The spinoglenoid ligament. Anatomy, morphology, and histological findings. J Bone Joint Surg Am. 2005;87:361–5. doi:10.2106/JBJS.C.01533.

    Article  PubMed  Google Scholar 

  5. Bach BR, Warren RF, Fronek J. Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J Bone Joint Surg (Br). 1988;70:274–6.

    CAS  Google Scholar 

  6. Arciero RA, Mazzocca AD. Mini-open repair technique of HAGL (humeral avulsion of the glenohumeral ligament) lesion. Arthroscopy. 2005;21:1152. doi:10.1016/j.arthro.2005.06.009.

    PubMed  Google Scholar 

  7. Spang JT, Karas SG. The HAGL lesion: an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments. Arthroscopy. 2005;21:498–502. doi:10.1016/j.arthro.2005.01.005.

    Article  PubMed  Google Scholar 

  8. Southgate DFL, Bokor DJ, Longo UG, et al. The effect of humeral avulsion of the glenohumeral ligaments and humeral repair site on joint laxity: a biomechanical study. Arthroscopy. 2013;29:990–7. doi:10.1016/j.arthro.2013.02.021.

    Article  PubMed  Google Scholar 

  9. Bankart AS. Recurrent or habitual dislocation of the shoulder-joint. Br Med J. 1923;2:1132–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Warner JJP, Beim GM. Combined bankart and HAGL lesion associated with anterior shoulder instability. Arthroscopy. 1997;13:749–52. doi:10.1016/S0749-8063(97)90012-8.

    Article  CAS  PubMed  Google Scholar 

  11. Hovelius L, Olofsson A, Sandström B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. A prospective twenty-five-year follow-up. J Bone Joint Surg Am. 2008;90:945–52. doi:10.2106/JBJS.G.00070.

    Article  PubMed  Google Scholar 

  12. Bui-Mansfield LT, Banks KP, Taylor DC. Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J Sports Med. 2007;35:1960–6. doi:10.1177/0363546507301081.

    Article  PubMed  Google Scholar 

  13. Safran O, Defranco MJ, Hatem S, Iannotti JP. Posterior humeral avulsion of the glenohumeral ligament as a cause of posterior shoulder instability. A case report. J Bone Joint Surg Am. 2004;86-A:2732–6.

    PubMed  Google Scholar 

  14. Castagna A, Snyder SJ, Conti M, et al. Posterior humeral avulsion of the glenohumeral ligament: a clinical review of 9 cases. Arthroscopy. 2007;23:809–15. doi:10.1016/j.arthro.2007.02.006.

    Article  PubMed  Google Scholar 

  15. Bigliani LU, Pollock RG, Soslowsky LJ, et al. Tensile properties of the inferior glenohumeral ligament. J Orthop Res. 1992;10:187–97. doi:10.1002/jor.1100100205.

    Article  CAS  PubMed  Google Scholar 

  16. Rhee YG, Cho NS. Anterior shoulder instability with humeral avulsion of the glenohumeral ligament lesion. J Should Elb Surg. 2007;16:188–92. doi:10.1016/j.jse.2006.06.017.

    Article  Google Scholar 

  17. George MS, Khazzam M, Kuhn JE. Humeral avulsion of glenohumeral ligaments. J Am Acad Orthop Surg. 2011;19:127–33.

    Article  PubMed  Google Scholar 

  18. Bokor DJ, Conboy VB, Olson C. Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Joint Surg (Br). 1999;81:93–6.

    Article  CAS  Google Scholar 

  19. Taljanovic MS, Nisbet JK, Hunter TB, et al. Humeral avulsion of the inferior glenohumeral ligament in college female volleyball players caused by repetitive microtrauma. Am J Sports Med. 2011;39:1067–76. doi:10.1177/0363546510391155.

    Article  PubMed  Google Scholar 

  20. Chang EY, Hoenecke HR, Fronek J, et al. Humeral avulsions of the inferior glenohumeral ligament complex involving the axillary pouch in professional baseball players. Skeletal Radiol. 2014;43:35–41. doi:10.1007/s00256-013-1744-y.

    Article  PubMed  Google Scholar 

  21. Nicola T. Anterior dislocation of the shoulder. J Bone Jt Surg. 1942;24:614–6.

    Google Scholar 

  22. Bokor DJ, Fritsch BA. Posterior shoulder instability secondary to reverse humeral avulsion of the glenohumeral ligament. J Should Elb Surg. 2010;19:853–8. doi:10.1016/j.jse.2010.01.026.

    Article  Google Scholar 

  23. Kon Y, Shiozaki H, Sugaya H. Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy. 2005;21:632. doi:10.1016/j.arthro.2005.02.004.

    Article  PubMed  Google Scholar 

  24. Magee T. Prevalence of HAGL lesions and associated abnormalities on shoulder MR examination. Skeletal Radiol. 2014;43:307–13. doi:10.1007/s00256-013-1778-1.

    Article  PubMed  Google Scholar 

  25. Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ. Humeral avulsions of the glenohumeral ligament: imaging features and a review of the literature. AJR Am J Roentgenol. 2002;179:649–55. doi:10.2214/ajr.179.3.1790649.

    Article  PubMed  Google Scholar 

  26. Oberlander MA, Morgan BE, Visotsky JL. The BHAGL lesion: a new variant of anterior shoulder instability. Arthroscopy. 1996;12:627–33. doi:10.1016/S0749-8063(96)90205-4.

    Article  CAS  PubMed  Google Scholar 

  27. Woertler K, Waldt S. MR imaging in sports-related glenohumeral instability. Eur Radiol. 2006;16:2622–36. doi:10.1007/s00330-006-0258-6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Waldt S, Burkart A, Lange P, et al. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. 2012.

    Google Scholar 

  29. Stoller DW. MR arthrography of the glenohumeral joint. Radiol Clin N Am. 1997;35:97–116.

    CAS  PubMed  Google Scholar 

  30. Ames JB, Millett PJ. Combined posterior osseous Bankart lesion and posterior humeral avulsion of the glenohumeral ligaments: a case report and pathoanatomic subtyping of “floating” posterior inferior glenohumeral ligament lesions. J Bone Joint Surg Am. 2011;93:e118. doi:10.2106/JBJS.K.00010 (1)–(4).

    Article  PubMed  Google Scholar 

  31. DJ B, CL O. Anterior shoulder instability secondary to lateral avulsion of the inferior gleno-humeral ligament. J Shoulder Elb Surg. 1996;5:S40. doi:10.1016/S1058-2746(96)80207-2.

    Article  Google Scholar 

  32. Pouliart N, Gagey O. Simulated humeral avulsion of the glenohumeral ligaments: a new instability model. J Should Elb Surg. 2006;15:728–35. doi:10.1016/j.jse.2005.11.013.

    Article  Google Scholar 

  33. Park KJ, Tamboli M, Nguyen LY, et al. A large humeral avulsion of the glenohumeral ligaments decreases stability that can be restored with repair. Clin Orthop Relat Res. 2014;472:2372–9. doi:10.1007/s11999-014-3476-2.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Murphy DT, Koulouris GC, Gopez AG, Kavanagh EC. Humeral avulsion of the glenohumeral ligament. AJR Am J Roentgenol. 2009;193:W74–5. doi:10.2214/AJR.08.2228; author reply W76.

    Article  PubMed  Google Scholar 

  35. Melvin JS, Mackenzie JD, Nacke E, et al. MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. AJR Am J Roentgenol. 2008;191:730–4. doi:10.2214/AJR.07.3631.

    Article  PubMed  Google Scholar 

  36. Schippinger G, Vasiu PS, Fankhauser F, Clement HG. HAGL lesion occurring after successful arthroscopic Bankart repair. Arthroscopy. 2001;17:206–8. doi:10.1053/jars.2001.21800.

    Article  CAS  PubMed  Google Scholar 

  37. Field LD, Bokor DJ, Savoie FH. Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: a cause of anterior shoulder instability. J Shoulder Elb Surg. 1997;6:6–10. doi:10.1016/S1058-2746(97)90064-1.

    Article  CAS  Google Scholar 

  38. Richards DP, Burkhart SS. Arthroscopic humeral avulsion of the glenohumeral ligaments (HAGL) repair. Arthroscopy. 2004;20 Suppl 2:134–41. doi:10.1016/j.arthro.2004.04.045.

    Article  PubMed  Google Scholar 

  39. Papalia R, Osti L, Del Buono A, et al. Management of combined ACL-MCL tears: a systematic review. Br Med Bull. 2010;93:201–15. doi:10.1093/bmb/ldp044.

    Article  PubMed  Google Scholar 

  40. Wolf EM, Cheng JC, Dickson K. Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthrosc J Arthrosc Relat Surg. 1995;11:600–7. doi:10.1016/0749-8063(95)90139-6.

    Article  CAS  Google Scholar 

  41. Bhatia DN, DasGupta B. 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. 2013;21:1603–9. doi:10.1007/s00167-012-2119-y.

    Article  PubMed  Google Scholar 

  42. Chhabra A, Diduch DR, Anderson M. Arthroscopic repair of a posterior humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion. Arthroscopy. 2004;20 Suppl 2:73–6. doi:10.1016/j.arthro.2004.04.032.

    Article  PubMed  Google Scholar 

  43. Baran S, Krych AJ, Dahm DL. Arthroscopic repair of the floating posterior-inferior glenohumeral ligament lesion. Arthrosc Tech. 2013;2:e209–12. doi:10.1016/j.eats.2013.02.007.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Imhoff AB, Ansah P, Tischer T, et al. Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med. 2010;38:1795–803. doi:10.1177/0363546510370199.

    Article  PubMed  Google Scholar 

  45. Buchmann S, Brucker PU, Beitzel K, et al. Long-term effects on subscapularis integrity and function following arthroscopic shoulder stabilization with a low anteroinferior (5:30 o’clock) portal. Knee Surg Sports Traumatol Arthrosc. 2015. doi:10.1007/s00167-015-3545-4.

    PubMed  Google Scholar 

  46. Scheibel M, Habermeyer P. Subscapularis dysfunction following anterior surgical approaches to the shoulder. J Should Elb Surg. 2008;17:671–83. doi:10.1016/j.jse.2007.11.005.

    Article  Google Scholar 

  47. Bhatia DN, DeBeer JF, van Rooyen KS. The “subscapularis-sparing” approach: a new mini-open technique to repair a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy. 2009;25:686–90. doi:10.1016/j.arthro.2008.12.001.

    Article  PubMed  Google Scholar 

  48. Brown T, Barton RS, Savoie FH. Reverse humeral avulsion glenohumeral ligament and infraspinatus rupture with arthroscopic repair: a case report. Am J Sports Med. 2007;35:2135–9. doi:10.1177/0363546507305012. http://ajs.sagepub.com.7200–0.emedia1.bsb–mu.

    Article  PubMed  Google Scholar 

  49. Hasan SS, Fleckenstein C, Albright J. Open treatment of posterior humeral avulsion of the glenohumeral ligaments: a case report and review of the literature. J Should Elb Surg. 2007;16:e3–5. doi:10.1016/j.jse.2006.09.009.

    Article  Google Scholar 

  50. Provencher M, McCormick F, Gaston T, et al. A prospective outcome evaluation of Humeral Avulsions of the Glenohumeral Ligament (HAGL) tears in an active population. Arthrosc J Arthrosc Relat Surg. 2014;30, e5. doi:10.1016/j.arthro.2014.04.017.

    Article  Google Scholar 

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Proier, P., Buchmann, S., Imhoff, A. (2016). Humeral Avulsion of the Glenohumeral Ligament Lesion (aHAGL and pHAGL): Current Concepts in Treatment and Management. In: Randelli, P., Dejour, D., van Dijk, C., Denti, M., Seil, R. (eds) Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49376-2_38

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