This 2011 JAAOS review by George et al synthesizes the anatomy, pathophysiology, diagnosis, and surgical management of HAGL lesions — avulsions of the inferior glenohumeral ligament from the humeral neck — as an underrecognized cause of recurrent traumatic shoulder instability.
When a patient has recurrent anterior shoulder instability — especially after a prior failed stabilization.
Suspect a missed HAGL lesion and obtain MR arthrography looking for a J-shaped axillary pouch; arthroscopic repair via the 5 o'clock and axillary pouch portals or a subscapularis-sparing mini-open approach can restore stability, but glenoid-side Bankart repair alone will not address humeral-side capsular incompetence.
This 2011 JAAOS review by George et al synthesizes the anatomy, pathophysiology, diagnosis, and surgical management of HAGL lesions — avulsions of the inferior glenohumeral ligament from the humeral neck — as an underrecognized cause of recurrent traumatic shoulder instability.
When a patient has recurrent anterior shoulder instability — especially after a prior failed stabilization.
Suspect a missed HAGL lesion and obtain MR arthrography looking for a J-shaped axillary pouch; arthroscopic repair via the 5 o'clock and axillary pouch portals or a subscapularis-sparing mini-open approach can restore stability, but glenoid-side Bankart repair alone will not address humeral-side capsular incompetence.