Humeral avulsion (pulling off) of the glenohumeral ligaments (HAGL) in the shoulder occurs in patients when they dislocate their shoulder. People who sustain a HAGL injury often have recurrent shoulder dislocations, subluxations or instability symptoms that affect their daily activities, work, sports or recreation. Repair of the ligaments is indicated. Surgery is often recommended for young, active individuals after the first dislocation with a HAGL injury because young patients have a high (80 percent or greater) likelihood of recurrent dislocations. Older patients with an anterior dislocation are less likely to re-dislocate and may do well without surgery as long as they do not sustain a fracture or rotator cuff tear with their injury. More commonly when someone dislocates their shoulder, the ligaments tear at a different location, off the glenoid (the shoulder socket). HAGL injuries are rare, often missed on an MRI, and most orthopaedic surgeons, even those specializing in shoulder care, are not able to fix this type of tear arthroscopically and prefer to approach these injuries through an open approach. With some special instruments and techniques, Dr. Steven Chudik finds the majority of HAGL injuries are reparable arthroscopically and achieve the goal of surgery, which is to repair the torn structures to stabilize the shoulder and prevent further instability or dislocations.
Dr. Chudik utilizes an arthroscopic approach through small incisions (arthroscopic portals) to repair the torn tissues. He repairs the tissues to the humerus with sutures and sometimes small bio-absorbable anchors. The anchors are inserted into the humerus and the sutures attached to the anchor are passed through the torn ligaments and tied to reattach the tissue. Immobilization in a sling for six weeks following surgery allows the torn capsule and ligaments to heal in proper position. By approximately four to six months following surgery, the repair site has healed and shoulder motion, strength and function are restored to allow a full return to activities.