Goodloe J Brett, Schwartz Joshua M, Tagliero Adam J, Klosterman Emma L, Brockmeier Stephen F
Sports Medicine Division, Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Video J Sports Med. 2023 May 10;3(3):26350254231161367. doi: 10.1177/26350254231161367. eCollection 2023 May-Jun.
Glenohumeral joint stability is reliant on a combination of static and dynamic constraints. Humeral avulsion of the posterior band of the inferior glenohumeral ligament (HAGL) is an exceedingly rare injury. These injuries can be difficult to diagnose and can lead to continued pain, dysfunction, and recurrent instability. There is a paucity of literature regarding surgical management of reverse HAGL lesions.
Many intrasubstance reverse HAGL lesions can be managed nonoperatively with rehabilitation focused on improving shoulder stability. Although the incidence of recurrent instability in patients with reverse HAGL lesions is unknown, the acute detached humeral lesions in athletes are often treated surgically to restore normal shoulder.
The patient was placed in a standard beach chair position, and the standard portals were made for a diagnostic shoulder arthroscopy. The anterior portal was the primary viewing portal. Using the initial posterior skin incision, instruments were introduced through the defect from the retracted posterior band of the inferior glenohumeral ligament. Using a combination of the 30° and 70° arthroscope, the HAGL was mobilized from the infraspinatus musculature. Two knotless suture devices (1.8-mm suture anchor, 2.6-mm suture anchor) were used to reduce the reverse HAGL lesion to an anatomical position, and the posterior capsule was closed thereafter.
Only case studies and a single case series have been published pertaining to reverse HAGL repair techniques and related outcomes. When diagnosed and treated appropriately, arthroscopic repairs yield promising results with a high percentage of patients returning to prior level of activity or returning to prior participation level in sport. However, outcome data are limited given the rare occurrence of this injury pattern.
DISCUSSION/CONCLUSION: Reverse HAGL pathology can be treated effectively with arthroscopic surgical repair to restore the normal capsular anatomy and prevent recurrent instability and persistent posterior shoulder pain. Using a 2-portal approach with posterior capsular closure is a minimally invasive operation that allows for appropriate management of these rare injuries.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
盂肱关节稳定性依赖于静态和动态约束的结合。肩胛下肌下盂肱韧带后束肱骨撕脱伤（HAGL）是一种极其罕见的损伤。这些损伤可能难以诊断，并可能导致持续疼痛、功能障碍和反复不稳定。关于反向HAGL损伤手术治疗的文献很少。
许多实质内反向HAGL损伤可以通过以改善肩部稳定性为重点的康复进行非手术治疗。虽然反向HAGL损伤患者反复不稳定的发生率尚不清楚，但运动员的急性肱骨离断损伤通常采用手术治疗以恢复正常肩部。
患者置于标准沙滩椅位，制作标准切口用于诊断性肩关节镜检查。前切口是主要观察切口。通过最初的后皮肤切口，器械经肩胛下肌下盂肱韧带回缩后的缺损处插入。使用30°和70°关节镜相结合的方式，将HAGL从冈下肌组织中游离出来。使用两个无结缝合装置（1.8毫米缝合锚钉、2.6毫米缝合锚钉）将反向HAGL损伤复位至解剖位置，然后关闭后关节囊。
仅有关于反向HAGL修复技术及相关结果的病例研究和单个病例系列发表。如果诊断和治疗得当，关节镜修复会产生有前景的结果，很大比例的患者可恢复到之前的活动水平或恢复到之前的运动参与水平。然而，鉴于这种损伤模式罕见，结果数据有限。
讨论/结论：反向HAGL病变可通过关节镜手术修复有效治疗，以恢复正常关节囊解剖结构，防止反复不稳定和持续的肩部后方疼痛。采用双切口入路并关闭后关节囊是一种微创手术，可对这些罕见损伤进行适当处理。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式。
