Definition
Humeral Avulsion of Glenohumeral Ligament (HAGL)
aHAGL - avulsion of anterior IGHL from the anterior / inferior humeral neck
Incidence
- 514 cases surgical treatment traumatic instability
- incidence of HAGL 7.5%
- incidence of HAGL without Bankart lesion 27%
- 25% associated subscapularis tear
Clinical
Suspect HAGL / capsular tear if
- anterior instability
- no bankart / anterior labral tear on MRI
Types
Soft tissue
- HAGL
- HAGL + Bankart lesion / anterior labral tear (floating HAGL)
Bony avulsions (BHAGL)
Bony avulsion HAGL
MRI
| Normal | HAGL / J Sign |
|---|---|
|
U shaped appearance Normal IGHL insertion on the humeral neck |
J shaped Avulsion of the IGHL |
 |
 |
Arthroscopy
Normal insertion onto humeral neck
Abnormal
Isolated HAGL
Options
Open repair
Arthroscopic repair
Results
Markus et al J Clin Orthop Trauma 2023
- systematic review of arthroscopic HAGL repair in 49 patients
- 81% return to sport
- 71% return to sport at same level
- 2% recurrent dislocation
Nicholson et al JSES Rev Rep 2024
- systematic review of HAGL repair in 46 athletes
- return to sport 94%
- return to sport at previous level 80%
- 6% recurrent instability
Open Technique
Surgical technique open HAGL PDF
Technique
- beach chair / deltopectoral approach
- detach lower half SSC with tenotomy
- repair IGHL via suture anchors into humeral neck
Arthroscopic Technique
Vumedi arthroscopic HAGL repair
Surgical technique arthroscopic HAGL repair PDF
Technique
- consider 70o scope
- trans-subscapularis portal SSC with arm adducted to avoid injury to MCN
- debride humeral insertion
- insert anchors through trans-subscapularis portal into humeral neck / curved anchors useful
- use suture passer from anteroinferior portal or from posterior portal
Bankart + HAGL (Floating)
Options
Open / arthroscopic repair both
Arthroscopic repair bankart / open HAGL
Arthroscopic repair bankart / leave HAGL
Technique
Open repair of floating HAGL surgical technique PDF