Nicholson Tyler C, Sandler Alexis B, Georger Lucas A, Klahs Kyle J, Scanaliato John P, Hettrich Carolyn M, Dunn John C, Parnes Nata
Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, TX, USA.
University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
JSES Rev Rep Tech. 2024 May 9;4(3):359-364. doi: 10.1016/j.xrrt.2024.04.012. eCollection 2024 Aug.
Anterior humeral avulsions of the glenohumeral ligament (aHAGL) lesions are relatively rare causes of shoulder instability that affect athletes at a higher rate than other populations. The purpose of this study is to evaluate rate of return to sport (RTS) after HAGL repair.
A search of the PubMed (MEDLINE), Scopus, and Cochrane CENTRAL databases was conducted on April 13, 2022 with the search terms "HAGL" or "humeral avulsion glenohumeral ligament" was used to conduct the systematic review. Inclusion criteria required that lesions were limited to aHAGL, axillary pouch or central HAGL, or both anterior and posterior HAGL lesions as specified by lesion description or direction of instability.
Screening and full-text manuscript review identified 7/967 studies eligible for inclusion with a total of 46 aHAGL lesions in athletes. Average rate of RTS was 93.5% (standard deviation [SD] = 13.4%, n = 43/46) with rate of RTS at previous levels of play averaging 80.0% (SD = 22.1%, n = 28/35). Neither rates of concomitant procedures nor concomitant pathology were associated with variation in RTS rates overall or level of RTS. Weighted average Rowe, subjective shoulder value, and Constant scores were 87.5 (SD = 4.9), 86.0 (SD = 2.0), and 82.2 (SD = 5.1), respectively, and 78.6% (n = 22/28) of patients reported postoperative satisfaction or "good/excellent" ratings following aHAGL repair. Adverse events occurred in 18.5% of patients (n = 10/54), most frequently recurrent instability (n = 3/54). Ultimately, 6.2% of patients eventually underwent reoperation (n = 3/17).
As with other forms of anterior shoulder instability, RTS rates after aHAGL repair are high and many patients achieve their previous level of play. The most frequent adverse event was subjective recurrent instability with reoperation in 6.2% of patients. The findings from this study provide valuable pooled data on outcomes specific to aHAGL repair, particularly in the athlete population, and contribute to further understanding of outcomes regarding operative management of this rare pathology.
盂肱韧带肱骨前方撕脱（aHAGL）损伤是导致肩关节不稳定的相对罕见原因，与其他人群相比，运动员受其影响的比例更高。本研究旨在评估HAGL修复术后的运动恢复率（RTS）。
2022年4月13日，使用检索词“HAGL”或“肱骨撕脱性盂肱韧带”在PubMed（MEDLINE）、Scopus和Cochrane CENTRAL数据库中进行检索，以开展系统评价。纳入标准要求损伤仅限于aHAGL、腋窝囊或中央HAGL，或根据损伤描述或不稳定方向确定的前后HAGL损伤。
筛选和全文稿件评审确定了7项符合纳入标准的研究，共涉及运动员中的46例aHAGL损伤。平均RTS率为93.5%（标准差[SD]=13.4%，n=43/46），恢复到之前运动水平的RTS率平均为80.0%（SD=22.1%，n=28/35）。伴随手术的发生率和伴随病理情况均与总体RTS率的变化或RTS水平无关。加权平均Rowe评分、主观肩关节评分和Constant评分分别为87.5（SD=4.9）、86.0（SD=2.0）和82.2（SD=5.1），78.6%（n=22/28）的患者在aHAGL修复术后报告了术后满意度或“良好/优秀”评级。18.5%的患者（n=10/54）发生了不良事件，最常见的是复发性不稳定（n=3/54）。最终，6.2%的患者最终接受了再次手术（n=3/17）。
与其他形式的前肩关节不稳定一样，aHAGL修复术后的RTS率很高，许多患者恢复到了之前的运动水平。最常见的不良事件是主观复发性不稳定，6.2%的患者接受了再次手术。本研究结果提供了关于aHAGL修复特定结果的有价值的汇总数据，尤其是在运动员人群中，有助于进一步了解这种罕见病理的手术治疗结果。
