title: Prospective Evaluation of Surgical Treatment of Humeral Avulsions of the Glenohumeral Ligament.
abstract: BACKGROUND
  Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss.
  
  
  OBJECTIVE
  To prospectively identify patients with HAGL lesions and then conduct retrospective evaluation of the clinical history, examination findings, and surgical outcomes of these patients.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Over a 6-year period (2006-2011), patients with shoulder dysfunction and a HAGL lesion that was 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 as well as Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE) scores were recorded at final follow-up. Anterior HAGL (aHAGL) lesions were repaired with a partial subscapularis tenotomy approach, while reverse (rHAGL) lesions were repaired arthroscopically.
  
  
  RESULTS
  Of 28 patients, 27 (96%) completed the study requirements at a mean of 36.2 months (range, 24-68 months). The sample contained 12 females (44%) and 15 males (56%), who had a mean age of 24.9 years (range, 18-34 years). The chief complaint reported was pain in 23 patients (85%), while only 4 (15%) patients complained primarily of recurrent instability symptoms. Fourteen patients (52%) had aHAGL lesions, 10 patients (37%) had rHAGL lesions, and 3 patients (11%) had combined aHAGL and rHAGL lesions. Ten patients (37%) had concomitant HAGL lesions and labral tears, whereas 17 patients (63%) had isolated HAGL lesion without labral tear. The 17 patients (63%) with aHAGL lesions or combined lesions underwent a partial subscapularis tenotomy approach, while the remaining 10 patients (37%) with rHAGL lesions underwent arthroscopic surgical repair. After surgery, WOSI outcomes improved from 54% to 88% and SANE outcomes improved from 50% to 91% ( P < .01 for both), with no reports in recurrence of instability symptoms at final follow-up.
  
  
  CONCLUSIONS
  This study demonstrated that patients with symptomatic HAGL lesions predominantly report shoulder pain and dysfunction, with few chief complaints of recurrent instability complaints. After surgery, patients showed predictable return to full activity, improvement in objective and patient-reported outcomes, and satisfaction with treatment outcome.
authors.affiliation: The Steadman Clinic, Vail, Colorado, USA.|Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Provencher
authors.affiliation: Sports Medicine Department, SOAR Institute, Miami, Florida, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.affiliation: Naval Branch Clinic Annapolis, Annapolis, Maryland, USA.
authors.forename: Lance
authors.initials: L
authors.lastname: LeClere
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: George
authors.initials: G
authors.lastname: Sanchez
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: Petar
authors.initials: P
authors.lastname: Golijanin
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Anthony
authors.affiliation: Rockwood Sports Orthopaedics, Spokane Valley, Washington, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Dewing
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D006811:Humerus / Q000473:pathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000473:pathology / Q000601:surgery*; D008297:Male; D009864:Ontario; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D058971:Tenotomy; D016896:Treatment Outcome; D055815:Young Adult
keywords: HAGL; dislocation; labral tears; outcome analysis; shoulder instability