Posterior avulsion of the gleno humeral ligament

1. 1
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Posterior humeral avulsion of the glenohumeral ligament (PHAGL) in anterior shoulder
instability
Franco Della Vedova, MD
1
, Maximiliano Ibáñez, MD
1
, Victoria Alvarez, MD
1
, Salvador Lépore, MD
1
, Vanina
Ojeda Sulzle, MD
1
, Hernán Galan, MD
1
, Daniel Slullitel, MD,
1,2
1
Instituto de Ortopedia Traumatología Dr. Jaime Slullitel, Sanatorio de la Mujer. Dirección: San Luis 2534. Rosario.
Argentina.
2
Universidad Abierta Interamericana. Av Pellegrini 1816. Rosario. Argentina.
Introduction
Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at
glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of
instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or
associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of
this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with
anterior shoulder instability.
Materials and Methods
We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All
6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated
intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed
preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores.
Results
All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores
results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83.
Discussion
Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was
initially described as a cause of posterior instability, but according to two other series, our study shows that
this lesion may also cause anterior instability.
It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this
injury, because arthroscopic repair of PHAGL has good postoperative outcomes.
The Orthopaedic Journal of Sports Medicine, 2(12)(suppl 4)
DOI: 10.1177/2325967114S00249
©The Author(s) 2014
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