Neviaser, Arthroscopy 1993 - The Anterior Labroligamentous Periosteal Sleeve Avulsion Lesion: A Cause of Anterior Instability of the Shoulder

The Anterior Labroligamentous Periosteal Sleeve Avulsion Lesion: A Cause of Anterior Instability of the Shoulder

Neviaser·Arthroscopy·1993·342 citations

Neviaser named the ALPSA lesion, an anterior labroligamentous periosteal sleeve avulsion, as a cause of recurrent anterior instability distinct from the Bankart lesion, and reported its arthroscopic repair.

8 acute first dislocations arthroscoped within 3 weeks of injury, then 26 ALPSA repairs (4 acute, 22 recurrent) followed at least 2 years.

Key Findings

Of 8 acute first‑time dislocations arthroscoped within 3 weeks, 4 had an ALPSA lesion and 4 a classic Bankart lesion.
In the ALPSA lesion the anterior scapular periosteum stays intact. Ligament, labrum and periosteum strip as a sleeve medially down the glenoid neck and rotate inferiorly.
All 22 recurrent dislocators operated on had a chronic ALPSA lesion, and none had a Bankart lesion.
After repair, all 4 acute patients and 21 of 22 recurrent patients had no instability on history or examination at 2 years or more.
One recurrent‑group patient redislocated at 2½ years after a fall playing soccer. Arthroscopy showed the ligament torn from a labrum still attached to the glenoid.
In the recurrent group, 20 of 22 regained motion equal to the other side by 9 months and 2 by 13 months. Only the examiner tested strength, finding external rotation equal to the other side in all.

Board pearl

ALPSA lesion: the labroligamentous sleeve avulses with intact periosteum and heals medially down the glenoid neck.

Authors' conclusion

Converting the ALPSA lesion to a Bankart lesion while per-forming a capsulorrhaphy with the Caspari (3) su-ture technique has been highly successful.

Core

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The Anterior Labroligamentous Periosteal Sleeve Avulsion Lesion: A Cause of Anterior Instability of the Shoulder

Neviaser·Arthroscopy·1993·342 citations

DOI·PubMed

8 acute first dislocations arthroscoped within 3 weeks of injury, then 26 ALPSA repairs (4 acute, 22 recurrent) followed at least 2 years.

Key Findings

Of 8 acute first‑time dislocations arthroscoped within 3 weeks, 4 had an ALPSA lesion and 4 a classic Bankart lesion.
In the ALPSA lesion the anterior scapular periosteum stays intact. Ligament, labrum and periosteum strip as a sleeve medially down the glenoid neck and rotate inferiorly.
All 22 recurrent dislocators operated on had a chronic ALPSA lesion, and none had a Bankart lesion.
After repair, all 4 acute patients and 21 of 22 recurrent patients had no instability on history or examination at 2 years or more.
One recurrent‑group patient redislocated at 2½ years after a fall playing soccer. Arthroscopy showed the ligament torn from a labrum still attached to the glenoid.
In the recurrent group, 20 of 22 regained motion equal to the other side by 9 months and 2 by 13 months. Only the examiner tested strength, finding external rotation equal to the other side in all.

Board pearl

ALPSA lesion: the labroligamentous sleeve avulses with intact periosteum and heals medially down the glenoid neck.

Authors' conclusion

Converting the ALPSA lesion to a Bankart lesion while per-forming a capsulorrhaphy with the Caspari (3) su-ture technique has been highly successful.