ALPSA Lesion or Bankart does it Really Matter in Shoulder Instability? A Review of Literature with Surgical Technique for ALPSA Repair

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Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  January-June 2021 | page: 14-18 | Timothy Weiwen Teo, Andy Teck Huat Wee

Author: Timothy Weiwen Teo [1], Andy Teck Huat Wee [1]

[1] Consultant Orthopaedic Surgeon Khoo Teck Puat Hospital

[2] Consultant Orthopaedic Surgeon Pinnacle Orthopaedic Group

Address of Correspondence
Dr. Timothy Weiwen Teo,
Consultant Orthopaedic Surgeon Khoo Teck Puat Hospital
E-mail: timothyteo.ww@gmail.com

Abstract

The anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion has been described as a distinct pathology from the classic Bankart lesion in anterior glenohumeral instability. ALPSA lesions are associated with younger patients, patients with more chronic symptoms, more episodes of pre-operative instability and associated with increased humeral and glenoid bone loss as compared to Bankart lesions. After surgery, ALPSA lesions also have a higher risk of redislocations and greater loss of range of motion. In this article, we outline some surgical pearls in dealing with ALPSA lesions.

Keywords: Anterior labroligamentous periosteal sleeve avulsion, bankart, traumatic anterior shoulder instability, labrum

References

1. KHovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 1982;166:127-31.
2. Bankart AS. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 1939;26:23-9.
3. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007;23:985-90.
4. Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: Acause of anterior instability of the shoulder. Arthroscopy 1993;9:17-21.

5. Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy 2008;24:1277-83.
6. Lee BG, Cho NS, Rhee YG. Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2011;19:1563-9.
7. Bernhardson AS, Bailey JR, Solomon DJ, Stanley M, Provencher MT. Glenoid bone loss in the setting of an anterior labroligamentous periosteal sleeve avulsion tear. Am J Sports Med 2014;42:2136-40.
8. Ahmad CS, Galano GJ, Vorys GC, Covey AS, Gardner TR, Levine WN. Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with single-and double-row capsulolabral repairs. J Shoulder Elbow Surg 2009;18:948-54.
9. Burkhart SS, de Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging HillSachs lesion. Arthroscopy 2000;16:677-94.
10. Farber JM, Buckwalter KA. Sports related injuries of the shoulder: Instability. Radiol Clin North Am 2002;40:235-49.
11. Elentuck D, Palmer WE. Direct magnetic resonance arthrography. Eur Radiol 2004;14:1956-67.
12. Shankman S, Bencardino J, Beltran J. Glenohumeral instability: Evaluation using MR arthrography of the shoulder. Skeletal Radiol 1999;28:365-82.
13. Magee T. 3-T MRI of the shoulder: Is MR arthrography necessary? AJR Am J Roentgenol 2009;192:86-92.
14. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res 1993;291:20-8.
15. Owens BD, Nelson BJ, Duffey ML, Mountcastle SB, Taylor DC, Cameron KL, et al. Pathoanatomy of first-time, traumatic, anterior glenohumeral subluxation events. J Bone Joint Surg Am 2010;92:1605-11.
16. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19:722-31.
17. Magee T, Williams D, Mani N. Shoulder MR arthrography: Which patient group benefits most? AJR Am J Roentgenol 2004;183:969-74
18. Gaunt BW, Shaffer MA, Sauers EL, Michener LA, McCluskey GM, Thigpen C. The American society of shoulder and elbow therapists’ consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther 2010;40:155-68.
19. Nolte PC, Arner JW, Cooper JD, Elrick BP, Millett PJ. Arthroscopic fixation of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the shoulder. Arthrosc Tech 2020;9:e553-8.

20. Spatschil A, Landsiedl F, Anderl W, Imhoff A, Seiler H, Vassilev I, et al. Posttraumatic anteriorinferior instability of the shoulder: Arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg 2006;126:217-22.
21. Zhu W, Lu W, Zhang L, Han Y, Ou Y, Peng L, et al. Arthroscopic findings in the recurrent anterior instability of the shoulder. Eur J Orthop Surg Traumatol 2014;24:699-705.

How to Cite this article: Teo TW,  Wee ATH. ALPSA Lesion or Bankart does it Really Matter in Shoulder Instability? A Review of Literature with Surgical Technique for ALPSA Repair. Journal of Clinical Orthopaedics Jan-Jun 2020;6(1): 14-18.

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