Recurrence Rates and Functional Outcomes Following Arthroscopic ALPSA Repair With Concomitant Remplissage: A Prospective Cohort Study.

Abstract

Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are often associated with higher failure rates after arthroscopic repair compared with non-ALPSA lesions. 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. Cohort study; Level of evidence, 2. 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. Failure rates were comparable between ALPSA (5.3%) and non-ALPSA (5.6%) groups (<i>P</i> = .94). Both groups achieved significant improvements in Rowe and WOSI scores (<i>P</i> < .001); however, patients with ALPSA had lower rates of achieving Patient Acceptable Symptom State (PASS) for WOSI (76.5% vs 92.2%; <i>P</i> = .007). Type C ALPSA repairs demonstrated inferior outcomes (WOSI PASS: 23.1% vs 100% for types A/B; <i>P</i> < .001). ALPSA repairs resulted in greater external rotation deficits (19° vs 14°; <i>P</i> < 01), particularly in type B repairs (23° deficit). 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.