Hoyt Benjamin W, Yow Bobby G, Feeley Scott M, Bloom Zachary J, Kilcoyne Kelly G, Rue John-Paul H, Dickens Jon F, LeClere Lance E
James A. Lovell Federal Health Care Center, Chicago, Illinois, USA.
Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Am J Sports Med. 2025 Jan;53(1):17-23. doi: 10.1177/03635465241295387.
Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are associated with recurrent shoulder instability and higher rates of failure after capsulolabral repair compared with similarly treated Bankart lesions. Although these lesions can portend poor outcomes, there are limited data on the associated conditions and postoperative course in a young, active population.
To evaluate the mid- to long-term clinical course and failure rates after ALPSA repairs and assess features associated with these outcomes.
Cohort study; Level of evidence, 3.
The authors identified all patients who underwent primary arthroscopic anterior or combined anterior and posterior labral repair between January 2010 and January 2020 at a single US military academy. Patient and injury characteristics were retrospectively reviewed while excluding patients with follow-up of <2 years. Patients were divided into 2 cohorts based on the presence of an ALPSA lesion as identified using arthroscopy, and patients with non-ALPSA lesions were matched to those with ALPSA lesions in a 5:1 ratio based on age, sex, time from injury to surgery, glenoid bone loss, and follow-up duration. The primary outcome measures were failure and revision surgery. Any recurrent shoulder instability event was considered a failure, including subjective or objective subluxation and/or dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. Survival analysis and both univariate and multivariate logistic regression analyses were performed to identify factors associated with ALPSA lesions and propensity for failure.
The authors compared 225 patients with non-ALPSA labral tears against 45 patients with ALPSA lesions. ALPSA lesions were associated with multiple preoperative dislocations (odds ratio [OR], 3.0; 95% CI, 1.5-5.9; = .00096) and increased prevalence of Hill-Sachs lesions (HSLs) (OR, 6.7; 95% CI, 2.8-16.0; < .0001) and near-track HSLs (OR, 3.6; 95% CI, 1.7-7.6; = .00049). At the final follow-up, there was no difference in overall failure or recurrent instability between patients with and without ALPSA lesions (20% vs 16% [ = .563] and 17.8% vs 10.2% [ = .147], respectively). On multivariate regression, ALPSA did not affect the likelihood of failure ( = .625). However, those with ALPSA lesions experienced failure earlier (1.7 vs 3.1 years; = .020). When revision ALPSA repairs were performed, 43% failed.
In patients with anterior instability treated with primary arthroscopic stabilization, ALPSA lesions were associated with HSLs and multiple dislocations. Although ALPSA repair failure occurred at a similar frequency in the mid- to long term compared with Bankart repairs, ALPSA repair failure tended to occur early in the postoperative course.
与类似治疗的Bankart损伤相比，前盂唇韧带骨膜袖套撕脱（ALPSA）损伤与复发性肩关节不稳定以及盂唇修复术后更高的失败率相关。尽管这些损伤可能预示着不良预后，但关于年轻活跃人群的相关情况和术后病程的数据有限。
评估ALPSA修复术后的中长期临床病程和失败率，并评估与这些结果相关的特征。
队列研究；证据等级，3级。
作者确定了2010年1月至2020年1月期间在美国一所军事院校接受初次关节镜下前盂唇或前后联合盂唇修复的所有患者。回顾患者和损伤特征，同时排除随访时间不足2年的患者。根据关节镜检查确定的ALPSA损伤情况将患者分为2个队列，非ALPSA损伤患者根据年龄、性别、受伤至手术时间、肩胛盂骨丢失和随访时间以5:1的比例与ALPSA损伤患者匹配。主要结局指标为失败和翻修手术。任何复发性肩关节不稳定事件均被视为失败，包括主观或客观半脱位和/或脱位、与不稳定一致的疼痛复发或功能受限性恐惧。进行生存分析以及单因素和多因素逻辑回归分析，以确定与ALPSA损伤和失败倾向相关的因素。
作者将225例非ALPSA盂唇撕裂患者与45例ALPSA损伤患者进行了比较。ALPSA损伤与术前多次脱位（优势比[OR]，3.0；95%可信区间[CI]，1.5 - 5.9；P =.00096）以及Hill-Sachs损伤（HSLs）患病率增加（OR，6.7；95%CI，2.8 - 16.0；P <.0001）和近迹HSLs（OR，3.6；95%CI，1.7 - 7.6；P =.00049）相关。在末次随访时，有和没有ALPSA损伤的患者在总体失败或复发性不稳定方面没有差异（分别为20%对16%[P =.563]和17.8%对10.2%[P =.147]）。在多因素回归分析中，ALPSA不影响失败的可能性（P =.625）。然而，有ALPSA损伤的患者失败发生得更早（1.7年对3.1年；P =.020）。当进行翻修性ALPSA修复时，43%失败。
在接受初次关节镜稳定治疗的前不稳定患者中，ALPSA损伤与HSLs和多次脱位相关。尽管从中长期来看，ALPSA修复失败的频率与Bankart修复相似，但ALPSA修复失败往往发生在术后早期。
