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. 2025 Aug 18;13(8):23259671251360365.
doi: 10.1177/23259671251360365. eCollection 2025 Aug.

Effect of ALPSA Tear Morphology on Redislocation Risk After Arthroscopic Repair

Toygun Kagan Eren  1 , Ethem Burak Oklaz  1 , Ahmet Emin Okutan  2 , Baran Sarikaya  3 , Furkan Aral  1 , Asim Ahmadov  1 , Ulunay Kanatli  1
Affiliations

Effect of ALPSA Tear Morphology on Redislocation Risk After Arthroscopic Repair

Toygun Kagan Eren et al. Orthop J Sports Med. .

Abstract

Background: Recent studies have emphasized the importance of lesion location and tear structure for understanding Bankart lesions; however, knowledge on anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion characteristics in anterior shoulder instability remains limited.

Purpose: To evaluate the prevalence of various ALPSA lesion patterns and their effect on redislocation rates after labrum repair.

Study design: Case-control study; Level of evidence, 3.

Methods: Patients with ALPSA lesions who underwent arthroscopic labrum repair between 2015 and 2022 were retrospectively evaluated. Labrum tears were categorized into specific positions: isolated ALPSA lesions (3- to 5-o'clock position), ALPSA lesions with tears extending to the 1 o'clock position (1- to 5-o'clock position), and ALPSA lesions with tears extending into other positions. In addition, transverse tears that disrupted the circular continuity of the labrum were defined as radial tears. Patients were categorized as having no dislocated lesions or having redislocated lesions based on postoperative redislocation history. Descriptive data, tear extensions, radial tears, and patient-reported outcome measures (PROMs) were compared between the 2 groups.

Results: The study included 178 patients (mean age, 25.7 ± 7.1 years), with a mean follow-up of 69.4 ± 27.2 months. Of these patients, 35 experienced lesion redislocation, while 143 patients did not experience lesion dislocation. In patients with no lesion dislocation, 43% of lesions were located in the 1- to 5-o'clock position, 36% in the 3- to 5-o'clock position, and 21% in other locations; in patients with lesion redislocation, 60% of lesions were observed in the 3- to 5-o'clock position, 29% in the 1- to 5-o'clock position, and 11% in other locations (P 1-5 = .04, P 3-5 = .001, and P others = .08). Radial tears were more frequent in the group with lesion redislocation (49%) compared with the group with no lesion dislocation (23%) (P < .001). Regression analysis demonstrated that radial tears (odds ratio [OR], 4.67) and the 3- to 5-o'clock lesion position (OR, 3.65) were significantly associated with redislocation (P = .01, P = .03, respectively). Both groups demonstrated significant improvements in PROMs compared with the preoperative period (P < .001). However, final follow-up PROMs were significantly worse in the group with lesion redislocation (P < .001).

Conclusion: The present study demonstrated that an isolated ALPSA lesion at the 3- to 5-o'clock position and the presence of radial tears were independent factors increasing the risk of redislocation after arthroscopic ALPSA repair.

Keywords: anterior labroligamentous periosteal sleeve avulsion lesion; labrum repair; redislocation; tear characteristics.

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Conflict of interest statement

The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Gazi University Ethics Committee (Protocol: 2024-1385).

Figures

Flowchart shows how many patients were excluded based on different health conditions; final study has 178 patients.
Figure 1.
Flowchart of the patient selection process. ALPSA, anterior labroligamentous periosteal sleeve avulsion; GLAD lesion, glenolabral articular disruption.
An illustrative diagram showing labral lesion types and their corresponding frequencies.
Figure 2.
Schematic illustration depicting the labral lesion locations and their frequencies.
A schematic illustrating the radial tear locations with their frequencies and counts.
Figure 3.
Schematic illustration depicting the radial tear locations and their frequencies.
The image presents two arthroscopic views of the left shoulder in lateral decubitus position, one from anterosuperior and one from posterior viewing portals.
Figure 4.
Arthroscopic view of the left shoulder, with the patient in the lateral decubitus position and the arthroscope in the (A) anterosuperior and (B) posterior viewing portals. (A) The image illustrates an ALPSA lesion viewed from the anterosuperior portal. (B) The image illustrates a radial tear at the 3 o'clock position and a retracted ALPSA lesion. ALPSA, anterior labroligamentous periosteal sleeve avulsion; HH, humeral head.
Arthroscopic view of the left glenohumeral joint, illustrating a radial tear in the biceps tendon. The SLIPS view shows the humeral head (H), glenoid labrum (GL), subscapularis muscle (SSC), and the location of the tear indicated by the red double-headed arrow.
Figure 5.
Arthroscopic view of the left shoulder, with the patient in the lateral decubitus position and the arthroscope in the posterior viewing portal. Illustration of the radial tear at the 1 o’clock position in a patient presenting with a labral tear extension. The red double-headed arrow shows a radial tear. ALPSA, anterior labroligamentous periosteal sleeve avulsion; BT, biceps tendon; G, glenoid; GL, glenoid labrum; H, humeral head; SSC, subscapularis.
See this image and copyright information in PMC

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