Rajagopalan Senthilvelan, Chodavarapu Mounika N S, Kambhampati Srinivas B S, Chinta Shyam Kumar, Kamineni Srinath
MIOT International, Chennai, Tamilnadu, India.
Siddhartha Medical College, Vijayawada, Andhra Pradesh, India.
Orthop J Sports Med. 2024 Aug 23;12(8):23259671241258198. doi: 10.1177/23259671241258198. eCollection 2024 Aug.
Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature.
To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies.
Scoping review; Level of evidence, 4.
The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords "ALPSA,""anterior labrum periosteal sleeve avulsion,""anterior labral periosteal sleeve avulsion," and "anterior labroligamentous periosteal sleeve avulsion" lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation.
This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures.
There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.
肩关节前盂唇骨膜袖套撕脱（ALPSA）损伤定义为盂唇撕脱且盂颈骨膜完整，导致盂唇内侧附着异常，这既不符合解剖结构，也失去了正常功能。与Bankart损伤相比，它相对少见，其相关结果在文献中通常与其他前盂唇韧带损伤合并报道。
（1）评估关于ALPSA损伤的文献规模和范围；（2）强调该损伤的重要性；（3）在诊断和治疗策略上区分ALPSA损伤与Bankart损伤。
范围综述；证据等级，4级。
在PubMed、Scopus、Embase和谷歌学术数据库中检索关键词“ALPSA”“前盂唇骨膜袖套撕脱”“前盂唇骨膜袖套撕脱伤”以及“前盂唇韧带骨膜袖套撕脱”损伤。排除重复文章和不符合纳入标准的文章，最终确定42篇相关文章。对其参考文献进行分析以进一步筛选数据。
本次范围综述表明，ALPSA损伤在临床上难以识别。内收内旋位的磁共振血管造影是最敏感且特异的识别影像学检查方法。最佳视野是关节镜检查时用于准确识别的前上入路以及用于手术修复的前下入路。治疗首先要正确识别盂唇，与致密的反应性纤维组织相区分，并将盂唇重新附着于正确的解剖学盂窝。伴有骨质丢失的慢性损伤需要进行骨块移植或软组织增强手术。
关于ALPSA损伤的专门文献较少。将该损伤与Bankart损伤区分开来很重要，因为它与更差的预后相关。ALPSA损伤修复的较高失败率表明，当前的修复技术需要进一步改进，以使治疗效果达到Bankart损伤的标准。
