Straight anterior instability: Lesions of the middle glenohumeral ligament

Purpose: Thirty-three patients with avulsions of the middle glenohumeral ligament repaired using arthroscopic techniques were evaluated to determine the mechanism of injury, physical examination findings, and efficiency of repair techniques in this patient cohort. Type of Study: In a retrospective consecutive case series, 33 patients with symptomatic anterior subluxation of the glenohumeral joint were found to have a history, physical examination, and diagnostic arthroscopy consistent with isolated avulsions of a type I middle glenohumeral ligament. Methods: The mechanism of injury was either repetitive overhead activity (17 patients) or a forced hyperextension in neutral rotations (16 patients). Physical examination was positive for a load and shift (fulcrum) testing of the middle glenohumeral ligament and "Whipple" testing of the anterior supraspinatus tendon. Magnetic resonance imaging with or without gadolinium was positive for anterior labral tearing in all 20 patients in which the test was performed. Results: Arthroscopic repair of the detached labrum resulted in decreased pain and improved function in all patients. Thirty-one of the patients were well satisfied, 1 was improved, and 1 was dissatisfied with the repair. Conclusions: Thirty-one of 33 patients graded as excellent, 1 good, and 1 poor in this study. Surgical repair of avulsions of the middle glenohumeral ligament provides satisfactory results in a majority of patients.