Hagl repair 2013 lf 2

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www.wrightington.com

Arthroscopic HAGL Repair

Lennard Funk Wrightington Hospital & Salford University

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Frequency

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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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www.wrightington.com 3

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MRA v Arthroscopy

  122 cases arthroscopic stabilisations   Incidence on Scope = 5%   Incidence on MRA = 5% ◦ MRA: ◦  Sensitivity = 66% ◦  Specificity = 33% ◦  PPV = 66% ◦ NPV = 33%

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Rukhtam, Harris, Funk. 2013. Unpublished

Scope&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

[email protected]

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Hagl repair 2013 lf 2

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