Table 1.

Abbreviated Surgical Outline

Basic Surgical Plan
Lateral decubitus position for the initial, arthroscopic portion
Standard posterior portal is established with a 5-mm cannula followed by an anterior midglenoid portal.
Anterior viewing portal is established to assess the posterior portion of the glenohumeral ligaments.
An elevator is used to detach the capsule from the scarred muscle fibers.
Side-to-side repair of the glenohumeral ligaments is performed with a suture lasso, no. 2 Ethibond sutures, and labral tape.
The main portion of the HAGL repair is performed.
Repositioning to the beach chair position.
A deltopectoral approach is done and dissection until the conjoint tendon is reached is performed.
Dissection is then continued until the subscapularis tendon can be identified through the deltopectoral interval.
The subacromial space is identified and debrided.
The subscapularis tendon and the anterior joint capsule are partially resected.
The reverse Hill-Sachs lesion is identified.
The bone defect is excised with an osteotome and smoothed with a power rasp.
A fresh talus allograft is molded and prepared for insertion into the Hill-Sachs defect.
The “orange slice”–shaped graft is press-fitted into the humeral head defect.
The subscapularis tendon is then repaired.
The wound is closed in layered fashion with absorbable suture.
The patient is then immobilized in a padded abduction sling.

HAGL, humeral avulsion of the glenohumeral ligament.