Recurrence Rates and Functional Outcomes Following Arthroscopic ALPSA Repair With Concomitant Remplissage: A Prospective Cohort Study

BACKGROUND: Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are often associated with higher failure rates after arthroscopic repair compared with non-ALPSA lesions. PURPOSE/HYPOTHESIS: The purpose of this study was to compare failure rates after arthroscopic ALPSA repair versus non-ALPSA (Bankart/Perthes) repair, with the effect of the Hill-Sachs lesions (HSLs) controlled by performing concomitant remplissage in all patients. It was hypothesized that addressing the Hill-Sachs defect would result in similar failure rates for both ALPSA and non-ALPSA repairs. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A prospective cohort study included 198 patients who underwent arthroscopic anterior labral repair with concomitant remplissage for anterior shoulder instability with an HSL. Patients were classified as ALPSA or non-ALPSA, and functional outcomes were analyzed in a matched cohort (N = 153), with a minimum 2-year follow-up. ALPSA lesions were subclassified intraoperatively based on repaired tissue quality and soft tissue bumper restoration into 3 types (A, B, and C). The primary outcome was the failure rate at 2-year follow-up. Secondary outcomes included Rowe scores, Western Ontario Shoulder Instability Index (WOSI) scores, and range of motion. RESULTS: < 01), particularly in type B repairs (23° deficit). CONCLUSION: Remplissage for concomitant HSL yields similarly low redislocation rates after both ALPSA and non-ALPSA repairs. Additionally, soft tissue bumper restoration is associated with improved functional outcomes at 2-year follow-up.