title: Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review.
abstract: To analyze clinical outcomes, range of motion, rate of recurrence, and complications after procedures to manage shoulder instability in patients with humeral avulsion of the glenohumeral ligament (HAGL) lesions.
  
  
  
  A systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a PRISMA checklist and algorithm was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the Keywords "shoulder," "HAGL," "treatment," "lesion," "dislocation," "instability," "clinical," "outcome," "Bankart" since inception of databases to 2015 was performed. All the investigators independently extracted the following data: demographics, types of lesions and associated injuries, treatment, outcome measurements, range of motion, recurrent instability, and complications.
  
  
  
  Eleven articles were included in which 42 shoulders with HAGL lesions were evaluated. Patients were assessed at a median follow-up period of 25.5 months, ranging from 12 to 54 months. The overall rate of recurrence was 0% (0 of 25) in case of surgery and 90% (9 of 10) in case of nonoperative treatment. The surgical approach was associated with lower rate of recurrence when compared with nonoperative treatment (odds ratio 0.05, 95% confidence interval 0.01 to 0.42, and P = .006). Only 2 papers reported loss of external rotation after surgery. No complications were reported after surgery. Complications after nonoperative treatment were not discussed.
  
  
  
  Recognizing HAGL lesions is important to manage patients with glenohumeral instability. Patients' complaints are often nonspecific. A high index of suspicion is required in patients with prior failed shoulder surgery. HAGL lesions are often associated with other shoulder lesions. Arthroscopic or open repairs of HAGL lesions are associated with good clinical outcomes and a lower rate of recurrence compared with nonoperative treatment.
  
  
  
  Level IV, systematic review of Level IV studies.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy. Electronic address: g.longo@unicampus.it.
authors.forename: Umile Giuseppe
authors.initials: UG
authors.lastname: Longo
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rizzello
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Ciuffreda
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Joel
authors.initials: J
authors.lastname: Locher
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Berton
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Salvatore
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D000070896:Bankart Lesions / Q000150:complications / Q000628:therapy; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000628:therapy*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012008:Recurrence; D012399:Rotation; D012783:Shoulder Dislocation / Q000150:complications / Q000628:therapy*; D012785:Shoulder Joint / Q000601:surgery*