Chapter 3 Instability

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CHAPTER 3 | Instability

HAGL (Humeral Avulsion of Glenohumeral Ligaments) Lesions in Anterior Instability HAGL lesions can be missed on diagnostic arthros- copy unless the surgeon is vigilant in specifically look- ing for them. They are best visualized through an FIGURE 3-70  The FiberWire from the inferior anchor is passed into the splice of the superior anchor, and the FiberWire from the superior anchor is passed into the splice of the inferior anchor. The sutures are pulled snug to the infraspinatus tendon but not tightened yet. IS, infraspinatus.

anterosuperolateral portal. Typically, the subscapularis is visible through the defect in the retracted capsule. The lesion may consist entirely of a capsular avulsion from the bone of the proximal humerus (Fig. 3-72), or it may predominantly be a capsular split that extends out to the humeral attachments with only a minor avulsion from the bone (Fig. 3-73). HAGL lesions may occur in combination with Bankart lesions. FIGURE 3-72  Right shoulder, anterosuperior viewing portal. The subscapularis muscle is visible through the defect created by the HAGL lesion. The anterior capsule has been avulsed from bone. SSc, subscapularis muscle; C, capsule; H, humeral head.

FIGURE 3-71  A: While visualizing from intra-articularly, the repair site is visualized from the ASL portal. B: The suture limbs are then tightened thus compressing the infraspinatus tendon down into Hill-Sachs defect. HSL, Hill-Sachs lesion; H, humeral head.