Summary

The findings from this study provide valuable pooled data on outcomes specific to anterior HAGL repair, particularly in the athlete population, and contribute to further understanding of outcomes regarding operative management of this rare pathology.

Abstract

Background

Humeral avulsions of the glenohumeral ligament (HAGL) lesions are relatively rare causes of shoulder instability that most commonly affect athletes. The majority of HAGL lesions are treated operatively due to high rates of recurrence in patients managed nonoperatively. However, there is a paucity of data describing return to sport (RTS) rates specific to anterior HAGL lesions.

Purpose

The purpose of this study is to further characterize how surgically repaired anterior HAGL tears may impact an athlete’s ability to RTS.

Methods

Systematic review of PubMed (MEDLINE), Scopus, and Cochrane CENTRAL databases for studies reporting RTS after HAGL repair identified 7/967 studies eligible for inclusion. HAGL lesions eligible for inclusion were limited to anterior (aHAGL), axillary pouch or central (cHAGL), or both anterior and posterior lesions as specified by lesion description or direction of instability. Posterior (pHAGL) lesions, bony aHAGL lesions, and reverse HAGL lesions were excluded, as were HAGL lesions undergoing revision procedures. Data related to patient demographics, athletic outcomes, functional outcomes, and adverse events were collected and pooled for analysis.

Results

In total, 46 athletes with aHAGL lesions were identified for inclusion. Of these, 93% (n=40/43) were specified as competitive or performance athletes and 60% (n=22/37) were considered contact or collision athletes. Average rate of RTS was 94% (SD=13%, n=43/46) with rate of RTS at previous levels of play averaging 80% (SD=22%, n=28/35). The odds of RTS at previous level was 14.8 times higher than RTS at a lower level (CI=0.77–282.5, Z=1.79) with significant heterogeneity among studies (I2=74%). The mean average time of return to play was 5.7 months (SD=0.67, n=18). As expected, there were significantly higher rates of concomitant procedures performed in patients with concomitant pathology (r(5)=0.825); however, neither rates of concomitant procedures or concomitant pathology were associated with variation in RTS rates (r(5)=0.570; r(5)=0.441, respectively). Similarly, rates of RTS at previous or higher level did not correlate with rates of concomitant procedures or pathology (r(3)=0.368; r(3)=0.51, respectively).

Weighted average Rowe, subjective shoulder value, and Constant scores were 87.5 (SD=4.9), 86.0 (SD=2.0), and 82.2 (SD=5.1), respectively. A majority (79%, n=22/28) of patients reported postoperative satisfaction.

Adverse events and occurred in 19% of patients (n=10/54). Of the patients experiencing complications, subjective instability was the most common (n = 8/10) with four patients reporting apprehension, three reporting recurrent instability, and one reporting subluxation. Ultimately, 6.2% of patients underwent reoperation (n = 3/17). Reoperations included revision with open Latarjet (n=1), arthroscopic revision HAGL repair (n=1), and biceps tenodesis (n=1).

Conclusion

RTS rates after anterior HAGL repair are 93.5%. Rates of RTS at previous levels are significantly higher than RTS at lower levels postoperatively, although not all patients will return to their pre-injury levels of play. Adverse events are not uncommon, with the most common adverse event noted to be subjective recurrent instability. The findings from this study provide valuable pooled data on outcomes specific to anterior HAGL repair, particularly in the athlete population, and contribute to further understanding of outcomes regarding operative management of this rare pathology.