And before I start, I'd like to thank everybody in the M.O.O.O.N.E. group for all their contributions to this project. You can see our disclosures online. So a bit of background. Shoulder dislocations, specifically anterior shoulder dislocations, occur in about 2% of the general population and can represent a source of disability and prevent return to sport, particularly in young athletic patients who are prone to recurrent dislocations. While we think of the injuries that classically occur with dislocations, most notably Bankart and Hilsack's lesions, a humeral avulsion of the glenohumeral ligaments is a less common but equally important pathology. These lesions occur in approximately 7% to 10% of patients with instability, but pose a significant clinical problem, as they can be difficult to identify on preoperative MRI and can result in continued shoulder dislocations if they are left unaddressed, with a quoted recurrence rate in the literature of up to 90% for untreated lesions. Currently, we also have a poor understanding of the patient factors that are associated with Haggle lesions, as contemporary data is mainly limited to small case theories, with very few comparative studies available that highlight any of the preoperative risk factors for a Haggle lesion being present. So given these challenges, we wanted to answer the following clinical questions. One was, what is the prevalence of Haggle lesions in a population of patients undergoing primary surgical treatment for shoulder instability? And two, what patient-related factors, preoperative findings, and surgical decisions are associated with the presence of a Haggle lesion? So in order to do this, we utilized data from the Moon Shoulder Group, looking at patients who were undergoing primary surgery for anterior shoulder instability from 2012 to 2020, with arthroscopy being used as the gold standard to identify Haggle lesions. We excluded five patients with isolated reverse Haggle lesions, but then compared patients with and without Haggles with respect to patient demographics, age, gender, BMI, number of lifetime dislocations, smoking, et cetera, as well as preoperative patient-reported outcomes, preoperative and intraoperative shoulder range of motion, and preoperative MRI findings. And then finally, we also performed logistic regression analysis to look at the factors that were independently associated with the presence of a Haggle lesion, as well as the need for a patient to undergo an open procedure. So we found that the overall prevalence of Haggle lesions in our cohort was 2.3%, a little bit lower than the previously reported literature, and that we saw that patients with Haggle lesions, as compared to those without, were less likely to have a Bancart lesion or a Hillstax lesion on their preoperative MRI. Between these two cohorts of Haggle and patients without Haggle lesions, we saw that the patients with Haggle lesions also had increased shoulder external rotation with the arm positioned at 90 degrees of abduction, as well as a slight increase in shoulder internal rotation with the arm at neutral. There was also a non-significant trend towards increased shoulder external rotation with the arm of 90 degrees of abduction in the patients with Haggle lesions when comparing their injured arm as compared to the uninjured arm. However, there are no differences in baseline patient demographics or preoperative PROs between the two groups. When we compared the types of procedures that were performed, we saw that patients with Haggle lesions were less likely to undergo any arthroscopic procedure, which was largely driven by lower rates of arthroscopic Bancart repair, and they were more likely to undergo open procedures, including open Bancart repair and open capsular shift. On multivariate regression analysis, we saw that the lack of a Bancart or the lack of a Hillstax lesion was independently associated with an increased odds of a Haggle lesion being present at the time of surgery, if those findings were not present on preoperative MRI. Additionally, we saw that the presence of a Haggle lesion was independently associated with an increased odds of a patient undergoing an open stabilization procedure, as was the presence of glenoid bone loss or patients who had greater than five dislocations in the year prior to surgery. So the main take-home points from our study are that the lack of a Bancart or Hillstax lesion on preoperative MRI should raise your index of suspicion that a Haggle lesion may be present in your patients who are undergoing surgery for anterior shoulder instability, and that the presence of a Haggle lesion was independently associated with a patient undergoing an open procedure. And this likely speaks to the fact that the open Haggle repair is a little less technically challenging and demanding than an arthroscopic one. Additionally, we did observe that Haggle lesions were present in 2.3% of patients in our cohort, which is a little lower than previously reported, and that although Haggle lesions did seem to affect shoulder range of motion in several planes, these differences were small and likely not clinically significant. And overall, these findings may be useful to surgeons who treat patients with shoulder instability, both in diagnosing Haggle lesions preoperatively and providing preoperative consultation to patients about any additional surgical procedures they may need in order to properly address their shoulder instability. There were several limitations to our study. We did rely upon accurate coding and data reporting by participating surgeons and staff. There were a limited number of patients with Haggle lesions in our cohort, which may have limited our ability to detect differences between groups. We did not have access to all available clinical data, including type of MRI, patient insurance status, and intraoperative lesion size. And then finally, postoperative PROs were not available to use for this study. So again, I'd like to thank all the members of the Moon Shoulder Group for their contributions to this project, as well as the research staff who has helped out immensely with everything. Thank you.

Haggle lesions

shoulder instability

prevalence

surgical treatment

diagnosis