Greiner Justin J, Setliff Joshua C, Dworkin Joshua D, Lin Albert
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Video J Sports Med. 2022 Aug 2;2(4):26350254221097980. doi: 10.1177/26350254221097980. eCollection 2022 Jul-Aug.
Combined posterior glenoid labrum lesions with posterior humeral avulsion of the glenohumeral ligament, also known as the "floating" posterior inferior glenohumeral ligament (PIGL), occur infrequently. These combined lesions are frequently missed on magnetic resonance imaging in the workup of posterior shoulder instability. Correct identification of the "floating" PIGL lesion allows for appropriate preoperative planning and treatment to decrease the risk of recurrent posterior shoulder instability.
A "floating" PIGL lesion is a cause of posterior shoulder instability and demonstrates increased translation when compared with isolated labral lesions. Surgical repair of an acute "floating" PIGL lesion with concomitant superior labral tear is described.
The patient is placed in the lateral decubitus position. Standard posterior and anterior portals are created. In this case, a superior labral tear with anterior labral tear extension was also identified and repaired. The posterior labrum was repaired prior to the posterior humeral avulsion of the glenohumeral ligament (HAGL). The torn posterior labrum is mobilized and glenoid bony bed prepared. Short, 2.9-mm biocomposite knotless suture anchors loaded with suture tape are used for labral fixation. A 70° arthroscope is used to visualize the posterior HAGL from the anterior cannula and an additional posterior inferior portal established. The footprint of PIGL on the humerus is identified, debrided, and two 3.0-mm anchors loaded with suture placed. The sutures are passed through the capsule and PIGL and tied in a mattress pattern external to the capsule and ligament. The posterior portals are closed with nonabsorbable suture.
While few outcomes are described in the literature for the "floating" PIGL, the literature suggests good outcomes following surgical repair.
The "floating" PIGL lesion is a rare cause of posterior shoulder instability. It is important to perform a thorough evaluation for concomitant pathology in patients with posterior shoulder instability as multiple structures can be injured. Arthroscopic repair of the posterior labrum and posterior humeral avulsion of the glenohumeral ligament can be performed to restore posterior stability to the shoulder in the setting of a "floating" PIGL.
合并后盂唇损伤与肱盂韧带后肱骨撕脱，也称为“漂浮”的下后盂肱韧带（PIGL），这种情况很少见。在评估后肩部不稳定时，这些合并损伤在磁共振成像中经常被漏诊。正确识别“漂浮”的PIGL损伤有助于进行适当的术前规划和治疗，以降低复发性后肩部不稳定的风险。
“漂浮”的PIGL损伤是后肩部不稳定的一个原因，与孤立的盂唇损伤相比，其移位增加。本文描述了对急性“漂浮”PIGL损伤合并上盂唇撕裂的手术修复。
患者置于侧卧位。建立标准的后外侧和前外侧入路。在这种情况下，还发现并修复了伴有前盂唇撕裂延伸的上盂唇撕裂。在肱盂韧带后肱骨撕脱（HAGL）之前修复后盂唇。将撕裂的后盂唇游离并准备盂骨床。使用装载缝线带的短2.9毫米生物复合材料无结缝合锚钉进行盂唇固定。使用70°关节镜从前侧套管观察后HAGL，并建立一个额外的后下外侧入路。识别、清理PIGL在肱骨上的附着点，并置入两个装载缝线的3.0毫米锚钉。缝线穿过关节囊和PIGL，并在关节囊和韧带外部以褥式缝合方式打结。后外侧入路用不可吸收缝线关闭。
虽然文献中很少描述“漂浮”PIGL的治疗结果，但文献表明手术修复后效果良好。
“漂浮”的PIGL损伤是后肩部不稳定的罕见原因。对于后肩部不稳定的患者，对合并病变进行全面评估很重要，因为可能有多个结构受损。在“漂浮”PIGL的情况下，可进行关节镜下后盂唇修复和肱盂韧带后肱骨撕脱修复，以恢复肩部的后稳定性。
