Dr. Garcia demonstrates his complex technique for arthroscopic HAGL repair

This video demonstrates Dr. Grant Garcia's advanced arthroscopic technique for a HAGL (Humeral Avulsion of the Glenohumeral Ligament) repair. A HAGL lesion is a specific type of shoulder injury where the inferior glenohumeral ligament (IGHL) is torn or pulled away from its attachment on the humerus (arm bone) rather than the socket side, resulting in significant anterior shoulder instability.

The surgical procedure is outlined through the following key clinical steps:

• Portal Placement & Visualization: Dr. Garcia establishes specialized viewing and working portals, often using a 70-degree arthroscope, to gain clear visual access to the deep anterior-inferior pocket of the shoulder joint where the humeral attachment lies.
• Tissue Identification & Mobilization: The torn, retracted edge of the inferior glenohumeral ligament is carefully identified and freed from surrounding scar tissue using an arthroscopic elevator. This ensures the ligament has enough mobility to be brought back to its native footprint on the humerus without tension.
• Humeral Bed Preparation: Using an arthroscopic shaver or burr, Dr. Garcia decorticates and prepares the bone bed on the neck of the humerus. Creating a raw, bleeding bone surface is critical for triggering a biological healing response between the bone and the ligament.
• Anchor Insertion & Ligament Reattachment: High-strength, low-profile suture anchors are drilled and placed directly into the prepared humeral neck footprint. Using specialized suture passers, Dr. Garcia takes robust bites through the avulsed ligament capsule and cinches the sutures down, securely anchoring the tissue back to the bone.

The final evaluation demonstrates that the native lower sling of the shoulder joint has been tightly reconstructed, restoring structural integrity and stopping the arm bone from abnormally sliding forward.