ALPSA vs Bankart Shoulder Repair, Which Wins?

Despite improvements in the arthroscopic treatment of anterior labroligamentous periosteal sleeve avulsion lesions (ALPSA), they are still associated with higher postoperative dislocation rates, according to a new study.

The study, “Outcomes of Arthroscopic Anterior Labroligamentous Periosteal Sleeve Avulsion Lesions,” was published online on April 13, 2022, in The American Journal of Sports Medicine.

“Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions can occur in recurrent anterior shoulder instability, which may lead to the labrum scarring medially to the glenoid. ALPSA lesions have also been associated with greater preoperative dislocations, larger Hill-Sachs lesions, and greater degrees of glenoid bone loss. Therefore, patients with these lesions have historically had a higher failure rate after repair, with nearly double the recurrent instability rate compared with those undergoing standard arthroscopic Bankart repair,” the researchers wrote.

The researchers compared minimum 2-year outcomes of arthroscopic mobilization and anatomic repair of ALPSA lesions with those after standard arthroscopic Bankart repair.

The researchers matched consecutive patients who underwent arthroscopic repair of ALPSA lesions to patients who underwent standard Bankart repair. Patient-reported outcome scores including American Shoulder and Elbow Surgeons, 12-Item Short Form Health Survey Physical Component Summary, Single Assessment Numeric Evaluation, shortened version of Disabilities of the Arm, Shoulder and Hand, as well as satisfaction scores were compared preoperatively and postoperatively.

They also analyzed recurrent instability, on-track versus off-track Hill-Sachs lesion and reoperation rates.

A total of 100 shoulders (25 ALPSA and 75 Bankart) with an overall mean age of 25.7 years were included in the study. Patients in the ALPSA group demonstrated improvements in the American Shoulder and Elbow Surgeons (preoperative, 74.8; postoperative, 89.7; p = .041) and Short Form Health Survey Physical Component Summary (preoperative, 46.9; postoperative, 53.4; p = .021) scores but not the Single Assessment Numeric Evaluation score (preoperative, 65.2; postoperative, 75.3; p = .311).

Patients in the Bankart group had significant improvements in all outcome scores at final follow-up: American Shoulder and Elbow Surgeons (preoperative, 67.1; postoperative, 90.3), Single Assessment Numeric Evaluation (preoperative, 58.0; postoperative, 85.7), and SF-12 PCS (preoperative, 45.3; postoperative, 52.9) (al p < .001).

There were no significant differences in patient-reported outcomes scores between the groups preoperatively or postoperatively (p > .05).

According to the analysis, the median satisfaction for the ALPSA group was 10 of 10 and for the Bankart group it was 9 of 10 (p = .094). There was a significantly higher rate of recurrent dislocation in the ALPSA group compared with the Bankart group ((32.0% vs. 13.3%; p = .040).

In addition, more patients in the Bankart group underwent revision surgery than those in the ALPSA group (20% vs. 10.7%).

“Despite improvements in the recognition of and surgical techniques for ALPSA lesions, they still lead to significantly higher postoperative dislocation rates; however, no different in patient-reported outcomes were found. These findings highlight the importance of early surgical interventions in anterior shoulder instability with the hope of lessening recurrent instability and the risk of developing an ALPSA lesion, as well as careful assessment of the quality of soft tissues and other risk factors for recurrence when considering what type of shoulder stabilization procedure to perform,” the researchers wrote.

Study authors include Justin W. Arner, M.D., Joseph D. Cooper, M.D., Bryant P. Elrick, M.D., Dylan R. Rakowski, Joseph J. Ruzbarsky, M.D., Marilee P. Horan and Peter J. Millett, M.D., all of Steadman Philippon Research Institute in Vail, Colorado.