TY - JOUR
T1 - Outcomes of Open Versus Arthroscopic Treatment of HAGL Tears
AU - Lee, Simon
AU - Krych, Aaron J.
AU - Peebles, Annalise M.
AU - Rider, Danielle
AU - Dekker, Travis J.
AU - Arner, Justin W.
AU - Ernat, Justin J.
AU - Whalen, Ryan J.
AU - Provencher, Matthew T.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: A.J.K. has received consulting fees from Arthrex, Joint Restoration Foundation, and Responsive Arthroscopy; speaking fees from Arthrex; and honoraria from the Joint Restoration Foundation. T.J.D. has received support for education from CGG Medica and Smith & Nephew, grants from DJO, and hospitality payments from Arthrex. J.W.A. has received hospitality payments from Mid-Atlantic Surgical Systems, Smith & Nephew, and Arthrex, and a grant from DJO. J.J.E. has received support for education from Arthrex, Gemini Mountain Medical, and Smith & Nephew; consulting fees from DePuy Synthes Products and Medical Device Business Services; and a grant from Arthrex. M.T.P. has received royalties from Arthrex, Anika, Responsive Arthroscopy, and Elsevier; consulting fees from Arthrex, Zimmer Biomet Holdings, the Joint Restoration Foundation, and SLACK; honoraria from Arthrosurface and Flexion Therapeutics; and grants from DJO. M.T.P. also served on the medical board of trustees for the Musculoskeletal Transplant Foundation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Publisher Copyright:
© 2023 The Author(s).
PY - 2023
Y1 - 2023
N2 - Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups (P <.001): SANE (mean ± SD; arthroscopic, 30.7 ± 15.7 to 92.1 ± 12.2; open, 45.5 ± 8.50 to 90.7 ± 5.24) and WOSI (arthroscopic, 51.4 ± 11.4 to 2.49 ± 3.70; open, 45.5 ± 7.37 to 11.5 ± 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Δ60.0; open, Δ46.5; P =.012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 ± 3.70; open, 11.5 ± 5.76; P =.00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability.
AB - Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups (P <.001): SANE (mean ± SD; arthroscopic, 30.7 ± 15.7 to 92.1 ± 12.2; open, 45.5 ± 8.50 to 90.7 ± 5.24) and WOSI (arthroscopic, 51.4 ± 11.4 to 2.49 ± 3.70; open, 45.5 ± 7.37 to 11.5 ± 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Δ60.0; open, Δ46.5; P =.012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 ± 3.70; open, 11.5 ± 5.76; P =.00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability.
KW - arthroscopy
KW - glenohumeral instability
KW - humeral avulsion of the glenohumeral ligament
UR - http://www.scopus.com/inward/record.url?scp=85152367510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85152367510&partnerID=8YFLogxK
U2 - 10.1177/03635465231164141
DO - 10.1177/03635465231164141
M3 - Article
AN - SCOPUS:85152367510
SN - 0363-5465
JO - The Journal of sports medicine
JF - The Journal of sports medicine
ER -