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Hagl repair 2013 lf 2
- 1. 23/03/2013!
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Lennard Funk
Wrightington Hospital & Salford University
Arthroscopic
HAGL Repair
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Frequency 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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1!
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MRA v Arthroscopy Rukhtam, Harris, Funk.
2013. Unpublished
122 cases arthroscopic stabilisations
Incidence on Scope = 5%
Incidence on MRA = 5%
◦ MRA:
◦ Sensitivity = 66%
◦ Specificity = 33%
◦ PPV = 66% Scope&
◦ NPV = 33% 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
lenfunk@shoulderdoc.co.uk
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