Clinical outcomes following arthroscopic repair of posterior humeral avulsion of glenohumeral ligament in recurrent anterior shoulder dislocations

Background: Anteroinferior labral tears, increasing glenoid bone loss, and concomitant Hill-Sachs lesions are the most common structural reasons discussed in the literature for recurrent anterior shoulder dislocation. The role of humeral avulsion of the glenohumeral ligament has been infrequently discussed, especially reverse or posterior humeral avulsion of the glenohumeral ligament (PHAGL). While most studies have linked PHAGL with posterior instability and pain, this study aimed to report the clinical outcomes of patients following arthroscopic repair of PHAGL in recurrent anterior shoulder dislocation. Materials and methods: A retrospective study was conducted on patients who had undergone arthroscopic treatment for recurrent anterior shoulder dislocation and PHAGL repair. Subjective and functional scores, including Rowe, Oxford Shoulder Instability Score (OSIS), and Single Assessment Numeric Evaluation (SANE), were used to assess each patient preoperatively and postoperatively at minimum 2-year mark. In addition, subgroup analyses were conducted involving on-track/off-track lesions and return-to-sports outcomes. Results: The study included 12 patients, 11 men and 1 woman, with a mean age of 36.4 ± 9.74 years (range, 21-48 years) and mean follow-up of 54.5 ± 34.41 months. The incidence of PHAGL was 6.2%. Postoperatively, all patients showed statistically significant improvements across all outcome measures (OSIS, Rowe, and SANE) at the end of the minimum 2-year follow-up. The rate of return to sports was 40%, with nonreturning patients having a higher incidence of off-track lesions and lower OSIS and SANE scores. However, the differences were not statistically significant. Conclusion: Recurrent anterior shoulder dislocation can be accompanied by a PHAGL lesion, with a prevalence rate of approximately 6.2%. While arthroscopic repair of this combination typically results in favorable clinical outcomes, the likelihood of returning to sports remains uncertain.