Arthroscopic repair of HAGL (Humeral Avulsion of Glenohumeral Ligament) lesions reattaches the torn anterior capsule and ligaments to the humerus. HAGL lesions are a less common but clinically distinct cause of anterior shoulder instability, where the inferior glenohumeral ligament tears off the humerus rather than the glenoid. Recognition is the first challenge because HAGL lesions are often missed on routine MRI and arthroscopy.
What Is HAGL Repair?
In a typical anterior shoulder dislocation, the labrum and capsule tear off the glenoid (a Bankart lesion). In a HAGL lesion, the same forces produce an avulsion at the humeral side instead: the inferior glenohumeral ligament tears off the humeral neck. The result is anterior instability with a normal-appearing glenoid labrum on imaging, which is why the diagnosis is often missed.
Arthroscopic HAGL repair reattaches the torn capsule and ligament to the humerus using suture anchors, restoring the anatomic stability of the inferior glenohumeral ligament.
Who Is a Candidate?
Candidates for HAGL repair typically have:
- Anterior shoulder instability with symptoms despite a normal-appearing glenoid labrum on MRI
- Documentation of HAGL lesion on MRI arthrogram or at arthroscopy
- Failed non-surgical treatment
- Active patients who require shoulder stability for sport or work
HAGL lesions are sometimes diagnosed incidentally during arthroscopy for other instability conditions, where the surgeon recognizes the humeral avulsion that imaging missed.
How the Procedure Is Performed
The procedure is performed arthroscopically through standard portals, with one or two additional portals tailored to access the inferior humerus. The joint is examined to confirm the HAGL lesion and rule out associated injury (Bankart tear, rotator cuff pathology).
The torn capsule and ligament are mobilized off the inferior humerus. The humeral neck is prepared with a small burr to create a healing surface. Suture anchors are placed in the humerus, typically two to three for a standard HAGL repair. Sutures are passed through the avulsed capsule and tied to reattach the tissue to the bone.
The procedure requires careful attention to portal placement to access the inferior humerus without injuring the axillary nerve, which runs in close proximity.
Recovery and Rehabilitation
Recovery follows the standard instability repair timeline:
- Sling protection for four to six weeks with passive motion within safe limits
- Progressive active motion from six weeks
- Strengthening from three months
- Return to non-contact sport at four to five months
- Return to contact sport at five to six months
Risks and Outcomes
Risks include axillary nerve injury (the closest neurovascular structure to the surgical field), recurrent instability, stiffness, and infection. Outcomes are good when the HAGL lesion is correctly identified and anatomically repaired. Missed HAGL lesions are a common cause of failed instability surgery, which is why recognition matters.
Why Dr. Chudik for HAGL Repair
Dr. Chudik treats the full spectrum of shoulder instability, including the less common HAGL lesion. His arthroscopic experience and high case volume of instability surgery produce familiarity with the imaging signs and intraoperative findings that distinguish HAGL from more common Bankart pathology, which is the foundation of getting this diagnosis right and treating it definitively.