Arthroscopic repair of posterior instability and reverse humeral glenohumeral ligament avulsion lesions.

Posterior glenohumeral subluxation is not as uncommon as once believed. Unidirectional instability as a result of a traumatic event or the primary direction of multidirectional instability as a result of overuse can lead to recurrent involuntary subluxations. Failure of the posterior restraints can occur at the glenoid labral attachment, mid-capsule, and laterally, as in a RHAGL avulsion. Soft tissue reattachment to bone is by way of suture anchors. This may occur at the glenoid medially or laterally along the humeral head insertion (RHAGL lesion). Capsular plication and superior shift can obliterate the capsular pouch. Additional labral lesions superiorly and anteriorly are repaired to centralize the humeral head and reduce the possibility of subcoracoid and subacromial impingement. Recurrence rates are reduced with symmetric repairs that address multiple lesions that are not always seen with a unidirectional open approach. Capsular tears, detachments, and the rotator capsular interval are reduced with minimal alterations in range of motion. Immobilization is combined with intermittent range of motion exercises. Protective scapular and rotator strengthening is a prerequisite before return to strenuous activities. Surgical repair followed by a well monitored rehabilitation protocol can return most individuals back to sport and vocation.