Review Question - QID 791

The clinical presentation and imaging studies are consistent with a humeral avulsion of the inferior glenohumeral ligament, also known as a HAGL lesion. If overlooked, HAGL lesions can cause a failure of Bankart repair (lesion is on the other end of the IGHL). The standard HAGL lesion refers to the anterior band of the IGHL, while with posterior instability you can have a reverse HAGL (RHAGL) involving the posterior band.

Abrams presents a review article on RHAGL lesions and associated posterior instability. They note that arthroscopic repair of the HAGL to the humerus, balanced capsular plication, and repair of associated labral tears reliably returns patients to their sport or vocation.

Wolf et al described their experience treating 64 patients with anterior shoulder instability. They identified a HAGL lesion in 9% of these patients and a Bankart lesion in 74% of patients.

Illustration A is an additional example of a coronal MR image demonstrating a HAGL lesion at the arrowheads. In this MRI arthrogram, contrast is seen extending down the humerus indicating a rupture of the inferior glenoid ligaments, which are seen attached on the glenoid side but not on the humeral side. Illustration B is an arthroscopic image of a HAGL lesion with the subscapularis muscle (SM) deep to the avulsed ligament off of the humeral neck (HN). Illustration C demonstrates the glenohumeral ligament anatomy. The video shows the inferior band of the glenohumeral ligament being reapproximated to the humerus.