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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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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 Unpublished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
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