Outcomes of Open Versus Arthroscopic Treatment of HAGL Tears

Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups (P < .001): SANE (mean +/- SD; arthroscopic, 30.7 +/- 15.7 to 92.1 +/- 12.2; open, 45.5 +/- 8.50 to 90.7 +/- 5.24) and WOSI (arthroscopic, 51.4 +/- 11.4 to 2.49 +/- 3.70; open, 45.5 +/- 7.37 to 11.5 +/- 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Delta 60.0; open, Delta 46.5; P = .012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 +/- 3.70; open, 11.5 +/- 5.76; P = .00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability.