Arthroscopic Repair of Anterior Humeral Avulsion of the Glenohumeral Ligaments

Traumatic anterior shoulder dislocation produces injury to the anterior glenohumeral ligament complex. Most commonly, this capsuloligamentous complex is torn off the anteroinferior glenoid neck (Bankart lesion). Creation of a humeral avulsion of the glenohumeral ligaments (HAGL lesion) is a much less common pathological result. Failure to identify and appropriately treat this entity frequently leads to recurrent dislocations. We describe the preferred arthroscopic techniques for identification and anatomical suture anchor repair of the anterior HAGL lesion. In a 4-year period, the senior author performed 215 operations for anterior shoulder instability. Six (2.8%) of these patients were diagnosed with anterior HAGL lesions and were treated with arthroscopic repair, as described below. At an average of 31.8 months of follow-up, no patients with an anterior HAGL repair have sustained recurrent dislocation or subluxation. The average University of California at Los Angeles shoulder score has improved from 18.3 to 33.0. All patients had good or excellent final result by the modified University of California at Los Angeles scoring system, and all were satisfied with the results of their operations.