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Review Question - QID 3165

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QID 3165 (Type "3165" in App Search)
A 23-year-old man acutely dislocates his shoulder for the first time while kayaking. His shoulder MRI is shown in Figures A and B. He undergoes arthroscopic Bankart repair and re-dislocates his shoulder within 1 month after surgery. What other pathology, besides the Bankart lesion, is likely contributing to this patient's recurrent instability?
  • A
  • B

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

  • A
  • B

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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.

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