AJSM - 2026-03-13 - Journal Article
Recurrence Rates and Functional Outcomes Following Arthroscopic ALPSA Repair With Concomitant Remplissage: A Prospective Cohort Study.
Helal A, El Tabbakh M, Omran AM, ELForse E, Mekky A, Haikal M
Topics
Key Takeaway
Concomitant remplissage equalizes redislocation rates between ALPSA and non-ALPSA repairs (5.3% vs 5.6%), but Type C ALPSA lesions achieve WOSI PASS in only 23.1% of patients versus 100% for Types A/B.
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Summary
This prospective cohort compared failure rates and functional outcomes after arthroscopic ALPSA versus non-ALPSA (Bankart/Perthes) repair, with remplissage performed in all patients to control for Hill-Sachs lesion engagement. Redislocation rates were equivalent (5.3% vs 5.6%, P=.94), but ALPSA patients achieved WOSI PASS less frequently (76.5% vs 92.2%, P=.007) and sustained greater external rotation deficits (19° vs 14°, P<.01). A novel intraoperative ALPSA subclassification (Types A, B, C) based on tissue quality and bumper restoration identified Type C as a distinct high-risk group with markedly inferior functional outcomes.
Key Limitation
Universal remplissage regardless of on-track/off-track classification prevents determination of whether the procedure was necessary in on-track ALPSA cases or whether the external rotation deficits it causes are justified in that subgroup.
Original Abstract
BACKGROUND
Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are often associated with higher failure rates after arthroscopic repair compared with non-ALPSA lesions.
PURPOSE/HYPOTHESIS
The purpose of this study was to compare failure rates after arthroscopic ALPSA repair versus non-ALPSA (Bankart/Perthes) repair, with the effect of the Hill-Sachs lesions (HSLs) controlled by performing concomitant remplissage in all patients. It was hypothesized that addressing the Hill-Sachs defect would result in similar failure rates for both ALPSA and non-ALPSA repairs.
STUDY DESIGN
Cohort study; Level of evidence, 2.
METHODS
A prospective cohort study included 198 patients who underwent arthroscopic anterior labral repair with concomitant remplissage for anterior shoulder instability with an HSL. Patients were classified as ALPSA or non-ALPSA, and functional outcomes were analyzed in a matched cohort (N = 153), with a minimum 2-year follow-up. ALPSA lesions were subclassified intraoperatively based on repaired tissue quality and soft tissue bumper restoration into 3 types (A, B, and C). The primary outcome was the failure rate at 2-year follow-up. Secondary outcomes included Rowe scores, Western Ontario Shoulder Instability Index (WOSI) scores, and range of motion.
RESULTS
Failure rates were comparable between ALPSA (5.3%) and non-ALPSA (5.6%) groups ( P = .94). Both groups achieved significant improvements in Rowe and WOSI scores ( P < .001); however, patients with ALPSA had lower rates of achieving Patient Acceptable Symptom State (PASS) for WOSI (76.5% vs 92.2%; P = .007). Type C ALPSA repairs demonstrated inferior outcomes (WOSI
PASS
23.1% vs 100% for types A/B; P < .001). ALPSA repairs resulted in greater external rotation deficits (19° vs 14°; P < 01), particularly in type B repairs (23° deficit).
CONCLUSION
Remplissage for concomitant HSL yields similarly low redislocation rates after both ALPSA and non-ALPSA repairs. Additionally, soft tissue bumper restoration is associated with improved functional outcomes at 2-year follow-up.