Arthroscopic Double-Row Repair of ALPSA Lesions: Prospective Outcomes at 2 and 5 Years Abstract

Background Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions represent a variant of anterior shoulder instability and are associated with higher recurrence rates after arthroscopic stabilization compared with classic Bankart lesions. Hypothesis Arthroscopic double-row capsulolabral repair would result in favorable clinical and functional outcomes in patients with ALPSA lesions. Study Design Case series. Level of Evidence Level 4. Methods A prospective case series was conducted on 50 patients with traumatic anterior shoulder dislocation and confirmed ALPSA lesions. Preoperative assessment included history, clinical examination, and functional scoring with the Instability Severity Index Score (ISIS), Constant Shoulder Score (CSS), and Rowe Score. All patients underwent arthroscopic double-row repair using a single medial anchor and three lateral anchors. A trans-subscapularis portal used to obtain an end-on trajectory for medial anchor placement. 48 Patients were followed clinically for 2 years, and remote follow-up at 5 years was conducted for 44 patients using a culturally adapted and validated translated version of the Simple Shoulder Test (SST). Results Constant Shoulder Score increased from a preoperative mean of 59.2 to 94.92 at 2 years (P<.001). External rotation in adduction decreased initially after surgery but recovered to a mean of 52.2° by 2 years. Forty-seven patients (97.9%) resumed their previous activity level, and no redislocations occurred. At 5 years, 44 patients completed SST follow-up, with scores ranging from 9 to 12 (mean 11.36), confirming good mid-term outcomes and no recurrent dislocations. Conclusion Arthroscopic double-row repair of ALPSA lesions resulted in good functional recovery, high return-to-activity rates, and no redislocations at both 2- and 5-year follow-up. This technique needs to be compared with single row repair of ALPSA lesion. Clinical Relevance This study provides prospective outcome data for assessment the arthroscopic double-row repair technique as a treatment option for ALPSA lesions in patients with anterior shoulder instability. What is known about this subject ALPSA lesions are associated with higher failure rates after arthroscopic stabilization compared with Bankart lesions, and restoration of the native capsulolabral anatomy is technically challenging. What this study adds to existing knowledge This study provides prospective mid-term clinical outcome data following arthroscopic double-row repair for ALPSA lesions, demonstrating favorable results in a selected low-risk population