What question did this study set out to answer?

To present the rare combination of ALPSA, Hill–Sachs, and HAGL lesions and their surgical treatment.

April 13, 2026SHILAP Revista de lepidopterología0 citationsOpen Access

Rare Presentation of Chronic Anterior Instability with Concomitant Triad of Anterior Labral Periosteal Sleeve Avulsion, Hill–Sachs, and Humeral Avulsion of the Glenohumeral Ligament Lesions: A Case Report

HEHady EzzeddineUniversity of Balamand RSRita SaadUniversity of Balamand WGWendy GhanemUniversity of Balamand

Key Points

To present the rare combination of ALPSA, Hill–Sachs, and HAGL lesions and their surgical treatment.
Case report of a 17-year-old female with recurrent shoulder dislocations and imaging-detected lesions.
All-arthroscopic repair strategy implemented, including ALPSA repair and Hill–Sachs remplissage.
Surgical techniques involved strategic anchor placement and precise suture management for HAGL repair.
The patient showed a near-normal range of motion at 18 months follow-up.
Excellent functional recovery was noted with no recurrence of instability.
Operative and postoperative outcomes reflected successful management of complex instability.

Abstract

Introduction: Traumatic anterior shoulder instability is common in young patients; however, the simultaneous occurrence of an anterior labral periosteal sleeve avulsion (ALPSA) lesion, Hill–Sachs defect, and humeral avulsion of the glenohumeral ligament (HAGL) is exceptionally rare. Managing multiple concurrent soft-tissue and bony injuries presents significant diagnostic and therapeutic challenges. This report describes a unique case of combined ALPSA, Hill–Sachs, and HAGL lesions treated with an all-arthroscopic approach, highlighting the importance of comprehensive evaluation and tailored surgical planning in complex instability patterns. Case Report: A 17-year-old female sustained a traumatic shoulder injury resulting in recurrent anterior dislocations, progressive pain, and functional weakness. Imaging revealed the coexistence of an ALPSA lesion, a significant Hill–Sachs defect, and a HAGL lesion. Given the complexity of instability, an all-arthroscopic repair strategy was adopted. The procedure included arthroscopic ALPSA repair to restore labral integrity, Hill–Sachs remplissage to address the engaging humeral defect, and arthroscopic HAGL repair using strategic anchor placement and precise suture management to re-establish capsuloligamentous continuity. Postoperative rehabilitation progressed uneventfully, and at 18 months follow-up, the patient demonstrated a near-normal range of motion, excellent functional recovery, and no recurrence of instability. Conclusion: The coexistence of ALPSA, Hill–Sachs, and HAGL lesions represents a rare and challenging clinical scenario. This case illustrates that a carefully planned all-arthroscopic approach can successfully restore shoulder stability and function while minimizing morbidity. Thorough assessment and individualized treatment strategies are essential for optimal outcomes in complex instability presentations. Further research is warranted to assess the long-term results of combined arthroscopic repair in such rare lesion patterns. Keywords: Anterior shoulder instability, anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligament, Hill–Sachs, arthroscopic repair.

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