Posterior Shoulder Instability: Outcomes Comparing Repairs for Tears of the Posterior Labrum and Reverse HAGL with...

Posterior humeral avulsion of glenohumeral ligament (PHAGL) lesions involves detachment of the posterior band of the inferior glenohumeral ligament from the humeral neck. Although uncommon, these lesions have been associated with recurrent instability.

To compare clinical outcomes and recurrence rates of patients with PHAGL lesions undergoing surgical repair for posterior shoulder instability versus a pair-matched control group without PHAGL lesions undergoing isolated arthroscopic posterior labral repair.

Cohort study; Level of evidence, 3.

This was a retrospective study of patients diagnosed with PHAGL lesions and posterior shoulder instability who underwent primary arthroscopic repair between 2010 and 2019. These patients were matched 1:3 with a cohort of patients with isolated posterior labral tears (PLTs). Demographics, surgical data, and pre- and postoperative clinical outcomes scores (American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Survey Physical Component Summary, and short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) were collected. Return-to-sport rates and satisfaction were also evaluated. Failure was defined as recurrent instability or progression to arthroplasty.

Nine patients diagnosed with PHAGL lesions who underwent primary arthroscopic repair were included. These 9 patients (PHAGL group) were age-matched to a cohort of 26 patients with PLTs who underwent repair (PLT group). The mean follow-up was 5.8 years (range, 2.0-14.2). No significant differences were found between the PHAGL and PLT groups regarding shoulder function, physical health, or patient satisfaction. The median satisfaction score for the PHAGL group was 8.5 of 10, compared to 10 of 10 for the PLT group (P = .144). One patient with PHAGL lesions experienced recurrent instability compared with 0 in the PLT group.

This study shows that patients with PHAGL lesions who undergo arthroscopic stabilization can attain comparable mid-term functional outcomes to those with isolated PLTs. Failure rates are similar between the PLT group and those with PHAGL lesions, and surgical management remains an effective treatment option for both groups. Further studies are needed to optimize surgical techniques and refine patient selection criteria for improved long-term success.