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

  • Symposium: Complex Issues in Glenohumeral Instability
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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° glenohumeral 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, anterior-inferior 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.

Conclusions

Anterior large HAGL lesions increase ROM and glenohumeral translation. After large HAGL lesion repair, stability of the shoulder can be restored.

Clinical Relevance

Surgeons should be aware of the possibility of HAGL lesions in patients with shoulder instability, and if large HAGL lesions are diagnosed, surgeons should consider repairing the lesions.

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Acknowledgments

The authors thank the VA Rehabilitation Research and Development Merit Review for providing partial funding for this study and Arthrex, Inc (Naples, FL, USA) for donating anchors used for repair.

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Authors and Affiliations

  1. Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th Street, Long Beach, CA, 90822, USA

    Kyoung Jin Park MD, PhD, Mallika Tamboli, Lauren Y. Nguyen, Michelle H. McGarry MS & Thay Q. Lee PhD

  2. Department of Orthopaedic Surgery, Chungbuk National University, Cheongju City, Chungbuk, Korea

    Kyoung Jin Park MD, PhD

  3. Department of Orthopaedic Surgery, University of California, Irvine, CA, USA

    Thay Q. Lee PhD

Authors
  1. Kyoung Jin Park MD, PhD
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  2. Mallika Tamboli
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  3. Lauren Y. Nguyen
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  4. Michelle H. McGarry MS
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  5. Thay Q. Lee PhD
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Corresponding author

Correspondence to Thay Q. Lee PhD.

Additional information

The institution of one or more authors (TQL) has received funding for this study by a grant from the VA Rehabilitation Research and Development Merit Review.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

All research conducted at the Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, CA, USA.

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Park, K.J., Tamboli, M., Nguyen, L.Y. et al. A Large Humeral Avulsion of the Glenohumeral Ligaments Decreases Stability That Can Be Restored With Repair. Clin Orthop Relat Res 472, 2372–2379 (2014). https://doi.org/10.1007/s11999-014-3476-2

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  • DOI: https://doi.org/10.1007/s11999-014-3476-2

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