{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:50:19Z","timestamp":1785171019586,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2007,8,1]],"date-time":"2007-08-01T00:00:00Z","timestamp":1185926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2007,8,1]],"date-time":"2007-08-01T00:00:00Z","timestamp":1185926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2007,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this article is to report the characteristic conditions in which a posterior humeral avulsion of the glenohumeral ligament (PHAGL) lesion occurs, defining also the different possibility of association with other intra\u2010articular shoulder pathologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified in our database 16 consecutive patients with a PHAGL lesion who underwent surgical treatment. Six of these patients had previous failed anterior shoulder stabilization, and 1 patient failed thermal shrinkage for a multidirectional instability and were not included in this study. The 9 remaining patients were enrolled in this study. All 9 patients developed a PHAGL lesion after a sports\u2010related trauma. Clinical symptoms reported by the patients and clinical examination data were variable depending also on associated intra\u2010articular shoulder pathology. The diagnosis of a PHAGL lesion was not made in any of the cases preoperatively. All 9 patients underwent arthroscopic repair of the PHAGL lesion. During the surgical procedure, any additional intra\u2010articular shoulder lesion was treated. Patients were evaluated preoperatively and postoperatively for pain and range of motion using standardized shoulder scales including the Simple Shoulder Test (SST), University of California Los Angeles (UCLA) rating score, and Constant score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Arthroscopic evaluation revealed that PHAGL was seen as an isolated lesion in only 3 patients. At a mean follow\u2010up of 34.2 months, all patients were pain free and reported a complete resumption of sports and daily living activities. Two patients had a limitation of internal rotation to the T11 level. The UCLA score improved from 16.3 to 34.7, the Constant score improved from 52.3 to 80.2, and the SST score improved from 7.9 to 4.2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PHAGL lesion is challenging to diagnose clinically. It can be the cause of posterior instability or a component of the spectrum of shoulder instability and associated with anterior labral or capsular pathology. Because physical examination can be misleading, a gadolinium\u2010magnetic resonance arthrogram and comprehensive arthroscopic evaluation visualizing from the anterior and posterior portals can confirm the diagnosis. We repaired the PHAGL lesions arthroscopically along with all associated shoulder abnormalities resulting in a good outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, therapeutic cases series.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2007.02.006","type":"journal-article","created":{"date-parts":[[2007,8,7]],"date-time":"2007-08-07T08:34:11Z","timestamp":1186475651000},"page":"809-815","source":"Crossref","is-referenced-by-count":69,"title":["Posterior Humeral Avulsion of the Glenohumeral Ligament: A Clinical Review of 9 Cases"],"prefix":"10.1002","volume":"23","author":[{"given":"Alessandro","family":"Castagna","sequence":"first","affiliation":[{"name":"Shoulder Service Surgery Humanitas Institute Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Snyder","sequence":"additional","affiliation":[{"name":"Southern California Orthopedic Institute Van Nuys California U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Conti","sequence":"additional","affiliation":[{"name":"Shoulder Service Surgery Humanitas Institute Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Borroni","sequence":"additional","affiliation":[{"name":"Shoulder Service Surgery Humanitas Institute Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Massazza","sequence":"additional","affiliation":[{"name":"Shoulder Service Surgery Humanitas Institute Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Garofalo","sequence":"additional","affiliation":[{"name":"Shoulder Service Surgery Humanitas Institute Milan Italy"},{"name":"Orthopaedic and Traumatology Unit University of Bari Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2007,8,1]]},"reference":[{"key":"e_1_2_2_2_1","first-page":"614","article-title":"Anterior dislocation of the shoulder: The role of the articular capsule","volume":"25","author":"Nicola T.","year":"1942","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_2_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546504271509"},{"key":"e_1_2_2_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465980260060301"},{"key":"e_1_2_2_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466020-00002"},{"key":"e_1_2_2_6_1","first-page":"149","volume-title":"The shoulder","author":"Hawkins R.J.","year":"1990"},{"key":"e_1_2_2_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199306000-00014"},{"key":"e_1_2_2_8_1","first-page":"273","volume-title":"Operative techniques of the upper extremity","author":"Tibone J.E.","year":"1996"},{"key":"e_1_2_2_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2004.04.032"},{"key":"e_1_2_2_10_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200412000-00022"},{"key":"e_1_2_2_11_1","first-page":"201","article-title":"Reverse HAGL: A possible complication of a tight anterior gleno\u2010humeral stabilization","volume":"90","author":"Castagna A.","year":"2005","journal-title":"Chir Organi Mov"},{"key":"e_1_2_2_12_1","first-page":"121","volume-title":"Shoulder arthroscopy","author":"Snyder S.J.","year":"2003"},{"key":"e_1_2_2_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.18002610104"},{"key":"e_1_2_2_14_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466020-00001"},{"key":"e_1_2_2_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100100205"},{"key":"e_1_2_2_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B1.0810093"},{"key":"e_1_2_2_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(97)90064-1"},{"key":"e_1_2_2_18_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.48B3.424"},{"key":"e_1_2_2_19_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.179.3.1790649"},{"key":"e_1_2_2_20_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.171.3.9725313"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S074980630700165X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S074980630700165X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2007.02.006","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2007.02.006","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2007.02.006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:15:24Z","timestamp":1773566124000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2007.02.006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,8]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2007,8]]}},"alternative-id":["10.1016\/j.arthro.2007.02.006"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2007.02.006","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,8]]}}}