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Superior labrum anterior posterior (SLAP) tear
4%
95/2419
Supraspinatus partial articular sided tendon avulsion (PASTA)
2%
56/2419
Humeral avulsion of the glenohumeral ligament (HAGL)
79%
1916/2419
Engaging (>25%) Hill Sachs defect
9%
221/2419
Anterior labral periosteal sleeve avulsion (ALPSA)
5%
111/2419
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The clinical scenario of recurrent dislocation after isolated Bankart repair suggests a failed Bankart repair or a missed concomitant injury. The MRI images (labeled in Illustrations A & B) demonstrate a humeral avulsion of the glenohumeral ligament (HAGL) which is known to contribute to shoulder instability and is a likely culprit for recurrent dislocation. Illustration C shows evidence of a Bankart lesion. Other abnormalities which can contribute to instability, but are not seen on the MRI, are rotator cuff tears, engaging Hill-Sachs deformity (a small Hill-Sachs is seen on the axial MRI image but is likely too small to contribute to instability), and labral tears. The article by Bui-Mansfield et al. reviews HAGL lesions while the paper by Rhee et al. reviewed their series of traumatic anterior instability patients and identified only 2% with a HAGL lesion with the majority occurring in concert with a Bankart lesion.
4.3
(29)
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