Humeral Avulsion of the Glenohumeral Ligament Lesions

The inferior glenohumeral ligament (IGHL) is crucial for anterior shoulder stability, and disruptions, known as HAGL lesions, often go unrecognized, potentially leading to persistent instability after shoulder surgery. There is limited research on surgical indications and outcomes for HAGL lesions.

Purpose

This systematic review aims to identify surgical indications for treating HAGL lesions and discuss reported outcomes.

Methods

A comprehensive literature search was conducted in MEDLINE, EMBASE, and Cochrane Library databases until May 25, 2016, using the keywords "humeral avulsion of the glenohumeral ligament" or "HAGL." Two reviewers screened eligible studies, and abstracted data were organized in table format.

Results

Eighteen studies comprising 118 patients who underwent surgical intervention for HAGL lesions were identified. The mean patient age was 22 years (range, 12-50 years), and 82% were male. Sports injuries accounted for 72% of HAGL injuries. Common surgical indications included primary anterior instability, pain, and failed nonoperative management. Associated injuries included Bankart lesions (15%), Hill-Sachs lesions (13%), and glenoid bone loss (7%). While outcome score reporting varied, all included studies reported significantly improved postoperative stability and function. No significant differences were found between open and arthroscopic surgical techniques. Most patients (all but two) returned to sports at their previous levels, including Olympians and professional athletes.