A Prospective Outcome Evaluation of Humeral Avulsions of the Glenohumeral Ligament (HAGL) Tears in an Active Population

Abstract

Objectives:Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss. The purpose of this study is to prospectively evaluate the clinical history, examination findings, and surgical outcomes of patients with HAGL lesions.Methods:Over a 6-year period, patients with shoulder dysfunction and a HAGL lesion confirmed via magnetic resonance arthrogram (MRA) were prospectively evaluated with a minimum 2-year follow-up. Patient demographics, presentation, examination and surgical findings were documented. Outcomes of return to activity and SANE and WOSI scores were recorded at final follow-up. Anterior HAGL (aHAGL) lesions were repaired with a mini-open approach, while reverse (rHAGL) lesions were repaired arthroscopically.Results:A total of 27 of 28 patients (96%) d the study requirements at a mean of 36.2 months (range 24-68 months). There were 12 females (44%) and 15 males (56%) with a mean age of 24.9 years (range 18-34). The primary complaint was pain in 23 patients (85%) and only 4 (15%) patients complained of instability symptoms. There were 14 patients (52%) with aHAGL lesions, 10 patients (37%) with rHAGL lesions, and 3 patients (11%) with combined anterior and posterior HAGL lesions. Ten patients (37%) had concomitant HAGL lesions and labral tears, whereas 17 patients (63%) presented with an isolated HAGL lesion. The 17 patients (63%) with aHAGL lesions or combined lesions underwent a mini-open surgical repair, while the remaining 10 patients (37%) with rHAGL lesions underwent arthroscopic surgical repair. After surgery outcomes improved from WOSI = 54%, SANE = 50% to WOSI = 88%, SANE = 91% (p<0.01).Conclusion:This study demonstrated that patients with symptomatic HAGL lesions complain predominantly of pain and shoulder dysfunction and present with few instability complaints or findings. After surgery, patients showed predictable return to full activity, improvement in objective and patient-reported outcomes, and patient satisfaction.