Humeral avulsion of the glenohumeral ligaments: the HAGL lesion.

BACKGROUND: Anterior instability of the shoulder is a frequently encountered clinical problem that is seen after avulsion of the capsulolabral complex from the glenoid rim (Bankart lesion). Recently, it has been determined that avulsion of the glenohumeral ligaments is an infrequent but important cause of recurrent instability after shoulder injury. Although the various forms of this injury have been described in the literature, no standardized nomenclature exists. This is of concern given the need for different surgical approaches to repair the various forms of this injury and therefore the inherent need to accurately convey the location of the avulsion and presence of concomitant injuries.

HYPOTHESIS: Based on the available literature for humeral avulsion of the glenohumeral ligament lesions, a nomenclature can be created to enhance the understanding and improve communication about these uncommon but important pathologic changes that occur with shoulder instability.

STUDY DESIGN: Systematic review.

METHODS: The findings pertaining to 6 patients with humeral avulsion of the glenohumeral ligament lesions encountered at our institution were combined with a literature search of the MEDLINE database conducted using the PubMed search engine of the National Library of Medicine and National Center for Biotechnology Information.

RESULTS: The West Point nomenclature was developed to clearly describe the various forms of humeral avulsion of the gleno-humeral ligament lesions encountered as well as their associated injuries.

CONCLUSIONS: The West Point nomenclature provides a practical and easy to understand means by which to classify humeral avulsion of the glenohumeral ligament lesions. This allows for more effective communication, which should result in improved clinical care.