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

Ahmed Helal¹, Mohammed El Tabbakh¹, Ali M Omran¹

¹Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, Egypt.

The American Journal of Sports Medicine

|March 13, 2026

Summary

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Arthroscopic repair of anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions with remplissage shows similar low failure rates to non-ALPSA repairs. However, ALPSA repairs may result in poorer functional outcomes and reduced external rotation.

Area of Science:

Orthopedic Surgery
Sports Medicine
Arthroscopy

Background:

Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are linked to higher failure rates after arthroscopic repair compared to non-ALPSA lesions.
Addressing Hill-Sachs lesions (HSLs) is crucial for successful anterior shoulder instability repair.

Purpose of the Study:

To compare failure rates between arthroscopic ALPSA repair and non-ALPSA (Bankart/Perthes) repair in patients with HSLs.
To evaluate the impact of concomitant remplissage in controlling HSL effects on repair outcomes.
To test the hypothesis that addressing HSLs leads to similar failure rates for both ALPSA and non-ALPSA repairs.

Main Methods:

Prospective cohort study of 198 patients undergoing arthroscopic anterior labral repair with remplissage for anterior shoulder instability and HSL.

Keywords:

Bankart repair Hill-Sachs remplissage anterior labroligamentous periosteal sleeve avulsion lesion shoulder instability

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Patients were categorized into ALPSA or non-ALPSA groups, with functional outcomes analyzed in a matched cohort (N=153) at minimum 2-year follow-up.

ALPSA lesions were subclassified (Type A, B, C) based on intraoperative tissue quality; primary outcome was 2-year failure rate, secondary outcomes included Rowe and WOSI scores, and range of motion.

Main Results:

Failure rates were comparable between ALPSA (5.3%) and non-ALPSA (5.6%) groups (P = .94).
Both groups showed significant improvements in Rowe and WOSI scores (P < .001), but ALPSA patients had lower Patient Acceptable Symptom State (PASS) for WOSI (76.5% vs 92.2%; P = .007).
Type C ALPSA repairs had inferior WOSI PASS (23.1% vs 100% for types A/B; P < .001) and greater external rotation deficits (23° for type B).

Conclusions:

Concomitant remplissage for HSLs results in similarly low redislocation rates for both ALPSA and non-ALPSA repairs.
Restoration of the soft tissue bumper is associated with improved functional outcomes at 2-year follow-up.
While redislocation rates are similar, ALPSA repairs, particularly Type C, may lead to suboptimal functional recovery and reduced range of motion.