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Hagl repair 2013 lf 2

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Lennard Funk
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23/03/2013! www.wrightington.com Lennard Funk Wrightington Hospital & Salford University Arthroscopic HAGL Repair 1 Frequency Mansfield et al. AJSM 2007   Literature review ◦  7 papers with 71 cases in total ◦  Incidence = 9% dislocations ◦  Rugby commonest MOI (42%) ◦  Associated injuries:   Labral tear - 23%   Cuff Tear - 25%   Hill-Sachs - 17% All radiographic studies - MRI or MRA 2 www.wrightington.com 3 www.wrightington.com 1!
23/03/2013! MRA v Arthroscopy Rukhtam, Harris, Funk. 2013. Unpublished   122 cases arthroscopic stabilisations   Incidence on Scope = 5%   Incidence on MRA = 5% ◦  MRA: ◦  Sensitivity = 66% ◦  Specificity = 33% ◦  PPV = 66% Scope& ◦  NPV = 33% Yes& No& MRA& Yes& 4& 2& 0.66&PPV& No& 2& 1& 0.33&NPV& 0.66&Sens& 0.33&Spec& 4 www.wrightington.com Injury Mechanism 5 www.wrightington.com 6 www.wrightington.com 2!
23/03/2013! Diagnosis   Antero-inferior Apprehension Sulcus 7 www.wrightington.com Diagnosis   Plain MRI (<24hrs) 8 www.wrightington.com 9 www.wrightington.com 3!
23/03/2013! Diagnosis   MR Arthrogram   J Sign 10 www.wrightington.com Arthroscopy 11 www.wrightington.com Bony HAGL 12 www.wrightington.com 4!
23/03/2013! Technical Tips 1.  Arm Positioner 2.  Portals 3.  Long Cannulae with Lids 4.  Sharp Suture Passers - AcuPass 5.  Disposable Drill Bits 6.  Anchors 1.  Biocomposites 2.  Curved 3.  Double Loaded 7.  Anaesthesia 8.  Rehabilitation 13 www.wrightington.com Arm Positioner 14 www.wrightington.com Surgical Steps 15 www.wrightington.com 5!
23/03/2013! 16 www.wrightington.com HAGL 17 www.wrightington.com Sharp Disposable Drill Bit 18 www.wrightington.com 6!
23/03/2013! Hard Bone 19 www.wrightington.com HAGL Case 1 20 www.wrightington.com HAGL Case 2 21 www.wrightington.com 7!
23/03/2013! Wounds 22 www.wrightington.com Outcomes   Sugaya (2007) = 3 cases with no FU   Our series (2013) = 5 cases, 14m FU ◦  1 recurrence (rugby) 23 www.wrightington.com www.wrightington.com Thank You lenfunk@shoulderdoc.co.uk 24 8!

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Hagl repair 2013 lf 2

  • 1. 23/03/2013! www.wrightington.com Lennard Funk Wrightington Hospital & Salford University Arthroscopic HAGL Repair 1 Frequency Mansfield et al. AJSM 2007   Literature review ◦  7 papers with 71 cases in total ◦  Incidence = 9% dislocations ◦  Rugby commonest MOI (42%) ◦  Associated injuries:   Labral tear - 23%   Cuff Tear - 25%   Hill-Sachs - 17% All radiographic studies - MRI or MRA 2 www.wrightington.com 3 www.wrightington.com 1!
  • 2. 23/03/2013! MRA v Arthroscopy Rukhtam, Harris, Funk. 2013. Unpublished   122 cases arthroscopic stabilisations   Incidence on Scope = 5%   Incidence on MRA = 5% ◦  MRA: ◦  Sensitivity = 66% ◦  Specificity = 33% ◦  PPV = 66% Scope& ◦  NPV = 33% Yes& No& MRA& Yes& 4& 2& 0.66&PPV& No& 2& 1& 0.33&NPV& 0.66&Sens& 0.33&Spec& 4 www.wrightington.com Injury Mechanism 5 www.wrightington.com 6 www.wrightington.com 2!
  • 3. 23/03/2013! Diagnosis   Antero-inferior Apprehension Sulcus 7 www.wrightington.com Diagnosis   Plain MRI (<24hrs) 8 www.wrightington.com 9 www.wrightington.com 3!
  • 4. 23/03/2013! Diagnosis   MR Arthrogram   J Sign 10 www.wrightington.com Arthroscopy 11 www.wrightington.com Bony HAGL 12 www.wrightington.com 4!
  • 5. 23/03/2013! Technical Tips 1.  Arm Positioner 2.  Portals 3.  Long Cannulae with Lids 4.  Sharp Suture Passers - AcuPass 5.  Disposable Drill Bits 6.  Anchors 1.  Biocomposites 2.  Curved 3.  Double Loaded 7.  Anaesthesia 8.  Rehabilitation 13 www.wrightington.com Arm Positioner 14 www.wrightington.com Surgical Steps 15 www.wrightington.com 5!
  • 6. 23/03/2013! 16 www.wrightington.com HAGL 17 www.wrightington.com Sharp Disposable Drill Bit 18 www.wrightington.com 6!
  • 7. 23/03/2013! Hard Bone 19 www.wrightington.com HAGL Case 1 20 www.wrightington.com HAGL Case 2 21 www.wrightington.com 7!
  • 8. 23/03/2013! Wounds 22 www.wrightington.com Outcomes   Sugaya (2007) = 3 cases with no FU   Our series (2013) = 5 cases, 14m FU ◦  1 recurrence (rugby) 23 www.wrightington.com www.wrightington.com Thank You lenfunk@shoulderdoc.co.uk 24 8!