title: Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion-a case series.
abstract: BACKGROUND
  Restoration of shoulder stability after humeral avulsion of glenohumeral ligament (HAGL) lesions can be achieved with arthroscopy, yet limited evidence exists on its benefit. We evaluated objective and subjective outcomes after arthroscopic refixation of a HAGL lesion.
  
  
  METHODS
  Between 2009 and 2012, 8 patients were treated arthroscopically for anterior shoulder instability associated with a HAGL lesion and invited for a follow-up examination. Radiographic assessment of joint centering and osteoarthritis, clinical assessment including Constant and Rowe scores, and complications as well as functional outcomes using the Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test were documented.
  
  
  RESULTS
  Six patients were postoperatively examined at a median time of 29 months (range, 12-38). Four patients had up to 6 previous luxation events. Two patients had a concomitant labral lesion, and another 2 had an associated rotator cuff tear. Positive preoperative apprehension and relocation test results for 5 patients were negative at follow-up. No neurologic lesion was noted both before and after surgery. Shoulder motion did not improve significantly; lower internal and external rotation relative to the contralateral shoulder was reported. The Rowe score improved significantly from baseline (median score change, 65 points; P = .027), with 2 and 4 patients rating "good" and "excellent" at follow-up, respectively. Final median Constant score, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test scores were 77.3 points, 91.0 points, 90%, and 87.5 points, respectively.
  
  
  CONCLUSIONS
  Arthroscopic stabilization of a HAGL lesion is a safe, feasible, and reproducible technique. In our patient cohort, good shoulder stability could be achieved with high patient satisfaction.
authors.affiliation: Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland. Electronic address: matthias.flury@kws.ch.
authors.forename: Matthias
authors.initials: M
authors.lastname: Flury
authors.affiliation: Research and Development Department, Schulthess Clinic, Zürich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Rickenbacher
authors.affiliation: Research and Development Department, Schulthess Clinic, Zürich, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Audigé
mesh_terms: D000328:Adult; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D055815:Young Adult
keywords: HAGL lesion; arthroscopy; case series; outcomes; refixation; shoulder instability