The document discusses the HAGL lesion and arthroscopic repair. It provides background on the incidence of HAGL lesions, associated injuries, and mechanisms of injury. Diagnosis methods including MRI, MR arthrogram, and arthroscopy are covered. Surgical technique tips and two case examples of arthroscopic HAGL repair are presented. Early outcomes from the literature and the author's series are reported, with one recurrence in their series.

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Lennard Funk
Wrightington Hospital & Salford University
Arthroscopic
HAGL Repair
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Frequency Mansfield et al. AJSM 2007
 Literature review
◦ 7 papers with 71 cases in total
◦ Incidence = 9% dislocations
◦ Rugby commonest MOI (42%)
◦ Associated injuries:
 Labral tear - 23%
 Cuff Tear - 25%
 Hill-Sachs - 17%
All radiographic studies - MRI or MRA
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MRA v Arthroscopy Rukhtam, Harris, Funk.
2013. Unpublished
 122 cases arthroscopic stabilisations
 Incidence on Scope = 5%
 Incidence on MRA = 5%
◦ MRA:
◦ Sensitivity = 66%
◦ Specificity = 33%
◦ PPV = 66% Scope&
◦ NPV = 33% Yes& No&
MRA& Yes& 4& 2& 0.66&PPV&
No& 2& 1& 0.33&NPV&
0.66&Sens& 0.33&Spec&
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Injury Mechanism
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Diagnosis
 Antero-inferior
Apprehension
Sulcus
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Diagnosis
 Plain
MRI
(<24hrs)
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Diagnosis
 MR
Arthrogram
 J Sign
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Arthroscopy
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Bony HAGL
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Technical Tips
1. Arm Positioner
2. Portals
3. Long Cannulae with Lids
4. Sharp Suture Passers - AcuPass
5. Disposable Drill Bits
6. Anchors
1. Biocomposites
2. Curved
3. Double Loaded
7. Anaesthesia
8. Rehabilitation
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Arm Positioner
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Surgical Steps
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HAGL
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Sharp Disposable Drill Bit
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Hard Bone
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HAGL Case 1
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HAGL Case 2
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Wounds
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Outcomes
 Sugaya (2007) = 3 cases with no FU
 Our series (2013) = 5 cases, 14m FU
◦ 1 recurrence (rugby)
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Thank You
lenfunk@shoulderdoc.co.uk
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