Shoulder instability is linked to HAGL lesions. The installation of an anterior-inferior (5 o’clock) portal is often required for arthroscopic repair of anterior HAGL lesions, with many modifications of this portal recorded. This study aimed to see if the previously published anterior-inferior shoulder arthroscopy portals are effective for arthroscopic anterior HAGL repair. Also, to see how arm adduction compares to conventional abduction during anterior-inferior portal development. In 12 cadaveric shoulders, HAGL lesions were generated and healed utilizing an all-arthroscopic method (matched pairs). Half of the repairs used a regular 5 o’clock portal, while Researchers used a medialized 5 o’clock portal for the other half of the matched pairs. They counted the number of anchor pullouts, and the repairs were timed. They measured the portal’s closeness to the cephalic vein, musculocutaneous nerve, axillary nerve, and lateral cord of the brachial plexus after the shoulders were dissected.

The average repair time for HAGL was 18.0 ±4.6 minutes. The median 5 o’clock portal (19.0 ± 3.3 min) and the standard 5 o’clock portal (16.2±5.8 min) did not differ substantially, with a p-value of 0.37. The distance between the cephalic vein and the standard 5 o’clock portal increased from 4.1 ± 4.7 mm to 5.2 ± 5.4 mm (p=0.02); the musculocutaneous nerve was 14.4±9.8 mm to 18.1 ± 10.8 mm (p=0.005); the axillary nerve 19.2 ±9.6 mm to 19.8 ±9.2 mm (p=0.12), and the lateral cord of the brachial plexus 13.8 ± 6.6 mm to 16.7 ± 6.4. Regardless of whatever portal is chosen—standard or medial 5 o’clock—the distance between the cephalic vein, musculocutaneous nerve, and lateral cord of the brachial plexus from the anterior-inferior portal is considerably affected by arm abduction angle. The arm should be in adduction when creating this gateway. Although proper anchor placement remains a problem, they can do arthroscopic HAGL repair safely. A medial 5 o’clock portal had little benefit. The typical 5 o’clock portal, when used with a curved guide, allows for repeatable anchor placement and is suggested for anterior HAGL repairs.

 

Reference:www.jshoulderelbow.org/article/S1058-2746(22)00199-9/fulltext