Straight anterior instability: Lesions of the middle glenohumeral ligament

Purpose: Thirty-three patients with avulsions of the middle glenohumeral li gament repaired using arthroscopic techniques were evaluated to determine t he mechanism of injury, physical examination findings, and efficiency of re pair techniques in this patient cohort. Type of Study: In a retrospective c onsecutive case series, 33 patients with symptomatic anterior subluxation o f the glenohumeral joint were found tr, have a history, physical examinatio n, 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 n eutral rotations (16 patients), Physical examination was positive for a loa d and shift (fulcrum) testing of the middle glenohumeral ligament and "Whip ple" testing of the anterior supraspinatus tendon. Magnetic resonance imagi ng with or without gadolinium was positive fur anterior labral tearing in a ll 20 patients in which the test was performed. Results: Arthroscopic repai r of the detached labrum resulted in decreased pain and improved function i n all patients. Thirty-one of the patients were well satisfied, 1 was impro ved, 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 re pair of avulsions of the middle glenohumeral ligament provides satisfactory results in a majority of patients.