鏡視下修復術を行った HAGL 病変の 3 症例

抄録

The purpose of this study was to report the short term results of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion.
We retrospectively evaluated three cases with HAGL lesion treated by arthroscopic repair between 2009 and 2011. Preoperative MR arthrography (MRA) showed a positive J sign on the oblique coronal image. There was one case with Bankart lesion and one case with rotator cuff tear. The mean follow-up period was 14 months. The humeral detachment of the inferior glenohumeral ligament (IGHL) was arthroscopically seen in all cases. Adequate visualization of the HAGL lesion was obtained with the 70° arthroscope with the arm internally rotated. The HAGL lesion was repaired with a suture anchor placed at the humeral insertion of the IGHL through an anteroinferior portal. Additional repair was also performed for Bankart lesion and rotator cuff tear.
Postoperative CT showed improper anchor placement in two cases with the anchor inserted with the arm internally rotated, and the proper anchor placement in one case with the anchor inserted with the arm externally rotated. Postoperative MRA showed a negative J sign and the normal tension of the IGHL. The average JSS instability score improved from 52.0 preoperatively to 85.3 postoperatively.
MRA was useful for the pre and postoperative evaluation for the HAGL lesion. For viewing thoroughly HAGL lesion, a 70° arthroscope was useful. Utilization of anteroinferior portal and anchor insertion with the arm externally rotated is necessary for proper anchor placement.