Identification and management of “floating” posterior inferior glenohumeral ligament lesions

Recurrent posterior glenohumeral instability, although a less common clinical entity than anterior instability, must be recognized and appropriately treated for a successful outcome. Pathologic findings that may need to be addressed include posterior Bankart lesions, humeral avulsion of the posterior inferior glenohumeral ligament (PIGHL), intrasubstance ligament attenuation, and combined lesions. In this review, we present 2 patients with the same pathoanatomic findings of recurrent posterior shoulder instability secondary to posterior humeral avulsion of the glenohumeral ligament with an associated posterior Bankart lesion. This combination of pathology is referred to as a “floating PIGHL” lesion. We review both patient's preoperative clinical findings and imaging studies and detail the necessary steps for a successful repair.