Surgical Management of Humeral Avulsion of the Glenohumeral Ligament Injuries: Indications, Treatment Strategies, and Outcomes.

Abstract

Purpose of review: This review aims to synthesize current knowledge on humeral avulsion of the glenohumeral ligament (HAGL) lesions, emphasizing clinical presentation, operative indications, and surgical outcomes.

Recent findings: HAGL lesions play an important role in shoulder instability, occurring in 7.5%-9.4% of surgically treated cases, with a high propensity to cause recurrent instability if left untreated. The sensitivity of magnetic resonance imaging for detecting HAGL lesions remains imperfect (50%- 83%), making arthroscopy the diagnostic gold-standard. Primary instability is the most common surgical indication (up to 82% of cases). Surgical repair, whether open or arthroscopic, yields excellent outcomes, with return to sport (RTS) rates of 81%- 100% and recurrent instability rates as low as 0%- 5.6%. Athletes may not always RTS at the same level (44%- 80%), however, and recurrent instability rates are higher in collision athletes (up to 21%). Limited data suggest a high incidence of recurrent instability in nonoperatively managed cases (up to 90%), although data on ideal indications for nonoperative management are lacking. HAGL lesions are an important yet often under-recognized cause of shoulder instability. Surgery is indicated in most cases due to its positive results, though comparative data between arthroscopic and open approaches are limited. Future research should refine imaging accuracy, directly compare arthroscopic versus open approaches, and enhance rehabilitation to improve pre-injury RTS rates.