To The Editor:
In the article "Arthroscopic Treatment of Anterior-Inferior
Glenohumeral Instability" (82-A: 991-1003, July 2000),
by Gartsman et al., the authors noted in the introduction
that Neviaser was the first to report on the anterior labroligamentous
periosteal sleeve avulsion (ALPSA) lesion. To my knowledge, when
Broca and Hartmann1reported on
the anterior dislocation of the shoulder in 1890, they first described
a periosteal sleeve avulsion lesion in detail. Later, McLaughlin2, Moseley and Övergaard3, and DePalma et al.4 also noted the periosteal sleeve
avulsion, including acute and old lesions, as a distinctive category
of intraarticular lesions involving anterior shoulder dislocation.
Although Dr. Neviaser’s 1993 report on the ALPSA lesion
alerted shoulder surgeons to the significance of this type of pathological
entity in arthroscopic surgery, he was not the first to report on
it. (Unfortunately, he did not refer to any previous reports.)
G.M. Gartsman, S.M. Hammerman, and T.S. Roddey reply:
We agree with Dr. Yoneda that other authors described the anterior
labroligamentous periosteal sleeve avulsion before Dr. Neviaser
did. That portion of our article did not attempt to assign historical
primacy. Neviaser’s seminal contribution was not that the
periosteal sleeve avulsion occurs, but that it may heal medially
on the scapular neck. Since Neviaser’s publication, surgeons
who encounter an ALPSA lesion dissect it from the scapular neck
and repair it laterally at the level of the glenoid rim. This change
in approach has resulted in improved patient outcomes following arthroscopic
operations for the treatment of recurrent glenohumeral instability.