Summary

Overall, arthroscopic repair of HAGL lesions offers significant improvements and must be considered in young patients and athletes.

Abstract

Purpose

Humeral avulsion of the glenohumeral ligament (HAGL lesion) is a rare but significant injury associated with shoulder instability. An undiagnosed HAGL lesion can lead to residual pain, loss of function, and recurrent instability even after surgical treatment. Although its incidence is low and the preferred treatment is surgical. The aim of this study is to evaluate the incidence of HAGL lesions associated with shoulder instability, as well as the functional outcomes and recurrence rate after arthroscopic surgical treatment.

Methods

We evaluated a total of 1100 patients who underwent arthroscopic reconstruction for shoulder instability with a diagnosis of glenohumeral instability from March 2009 to March 2023 . Patients of both sex aged 15 to 45 years old, with a preoperative or intraoperative diagnosis of a HAGL lesion and a minimum follow-up of one year, were included. Pre and postoperative assessments included range of motion, functional outcomes using the Constant score, WOSI (Western Ontario Shoulder Instability Index), ASES (American Shoulder and Elbow Surgeons), SST (Simple Shoulder Test), and Visual Analog Scale (VAS) for pain.

Results

Twenty-two patients underwent arthroscopic repair of HAGL lesions, showing an incidence of 2% (22/1100). The average age at the time of surgery was 26.2 years (SD=9.4), and the follow-up period was 61 months (SD=59.7). Eleven patients (78.6%) participated in contact/collision sports: ten in rugby (45%), eight in soccer (33%), three in boxing (14%), and one remaining patient (8%) practiced CrossFit. In 55% of cases (12 patients), the diagnosis was made intraoperatively. All patients presented with associated injuries: labral lesions (63%), rotator cuff lesions (17%), Hill-Sachs lesions (10%), biceps pathology (7%), and SLAP (Superior Labrum Anterior and Posterior) lesion associated with spinoglenoid cyst (3%). Functional scores register were WOSI 94,7 ASES 95, SST 11 and VAS justo two patients reports 2/10 in this scale. Three patients (13%) reported discomfort during overhead activities, and 1 patient (7%) experienced recurrence 18 months after surgery treated with Latarjet surgery. 95,5% of the patients returned to their previous level and sport activities, nonetheless one patient referred poor results changing rugby for cycling.

Conclusión: The HAGL lesion is uncommon, and its diagnosis is often made intraoperatively. Even though it's technically demanding, according to our series arthroscopic treatment is associated with favorable short and medium term results. Effective postoperative rehabilitation is crucial for restoring shoulder function and strength. Overall, arthroscopic repair of HAGL lesions offers significant improvements and must be considered in young patients and athletes.

Level of evidence : Case series, level IV.
Key words: Instability; Shoulder; Arthroscopy; HAGL; Bankart.