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Posterior Shoulder Instability: Outcomes Comparing Repairs for Tears of the Posterior Labrum and Reverse HAGL with
Jason Long1,2, Ajay Kanakamedala1,2, Christopher J Hawryluk1
1Steadman Philippon Research Institute, Vail, Colorado, USA.
Orthopaedic Journal of Sports Medicine
|March 5, 2026
Summary
Posterior humeral avulsion of glenohumeral ligament (PHAGL) lesions can be effectively treated with arthroscopic stabilization, achieving similar outcomes to isolated posterior labral repairs. This surgical approach offers comparable mid-term functional results and low failure rates for posterior shoulder instability.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Instability Research
Background:
- Posterior humeral avulsion of glenohumeral ligament (PHAGL) lesions involve the detachment of the posterior band of the inferior glenohumeral ligament from the humeral neck.
- These uncommon lesions are associated with recurrent posterior shoulder instability.
Purpose of the Study:
- To compare clinical outcomes and recurrence rates in patients with PHAGL lesions undergoing surgical repair versus a matched control group with isolated posterior labral tears (PLTs).
Main Methods:
- Retrospective cohort study (Level of evidence, 3) of patients undergoing arthroscopic repair for PHAGL lesions or PLTs between 2010 and 2019.
- Patients were matched 1:3, and pre- and postoperative clinical outcome scores, return-to-sport rates, and satisfaction were evaluated.
- Failure was defined as recurrent instability or progression to arthroplasty.
Main Results:
- Nine patients with PHAGL lesions and 26 with PLTs were analyzed with a mean follow-up of 5.8 years.
- No significant differences were observed in shoulder function, physical health, or patient satisfaction between the groups.
- One PHAGL patient experienced recurrent instability versus none in the PLT group.
Conclusions:
- Arthroscopic stabilization for PHAGL lesions yields comparable mid-term functional outcomes to isolated PLT repair.
- Surgical management is an effective treatment for both PHAGL lesions and PLTs, with similar failure rates.
- Further research is needed to optimize surgical techniques and patient selection for improved long-term results.
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