The ALGR procedure, or Anterior Ligament of the Glenohumeral Reinforcement, is a specialized surgical technique designed to address shoulder instability. This procedure strengthens the anterior structures of the glenohumeral joint to prevent recurrent dislocations. By reinforcing weakened tissues, ALGR aims to restore the shoulder’s natural stability and function.
Understanding Shoulder Instability
The shoulder is a ball-and-socket joint where the head of the humerus (upper arm bone) fits into the glenoid fossa (a shallow socket on the shoulder blade). This design allows for a wide range of motion, making it the body’s most mobile, yet inherently less stable, joint. Several structures contribute to its stability, including the glenoid labrum and the glenohumeral ligaments.
The labrum is a ring of fibrous cartilage that surrounds the glenoid, deepening the socket and helping to keep the humeral head centered. Glenohumeral ligaments, especially the inferior glenohumeral ligament (IGHL), are thickenings of the joint capsule that reinforce the anterior shoulder. The IGHL is important for stability when the arm is abducted beyond 45 degrees, resisting anterior, posterior, and inferior movement.
Shoulder instability occurs when these stabilizing structures are damaged, allowing the humeral head to move relative to the glenoid fossa. A shoulder dislocation happens when the humeral head completely displaces from the glenoid, often due to trauma. Anterior dislocations are the most common type, typically caused by excessive extension and external rotation of the humerus.
A common injury from anterior shoulder dislocation is a Bankart lesion. This involves a detachment of the anterior and inferior glenoid labrum from the glenoid rim, often with an associated injury to the anterior band of the IGHL. A Bankart lesion compromises shoulder stability by disrupting the labrum’s buttressing effect and the IGHL’s function, leading to recurrent instability.
The ALGR Surgical Procedure
The ALGR procedure is an advanced form of arthroscopic Bankart repair, a common surgical technique for anterior shoulder instability. Arthroscopy is a minimally invasive approach where a surgeon uses a small camera and instruments through tiny incisions to visualize and repair the joint. A Bankart repair aims to reattach the torn labrum and tighten the stretched capsule to the glenoid rim.
The ALGR technique reinforces the primary labral repair using a portion of the inferior glenohumeral ligament (IGHL). This augmentation restores capsular tension by tightening the anterior band of the IGHL, often by suturing the labrum to an anchor on the glenoid. This creates a “south-to-north” capsulolabral shift, providing additional stability.
Surgeons may choose ALGR when labrum or capsule tissue quality is compromised, or for patients at higher risk of re-dislocation. This includes individuals with multiple dislocations, generalized joint laxity, or athletes in high-demand contact and collision sports. The procedure aims to create a more resilient and durable anterior shoulder stabilization.
Recovery and Rehabilitation Protocol
Recovery following an ALGR procedure is a structured process, divided into distinct phases for proper healing and restoration of function. Immediately after surgery, the shoulder is immobilized in a sling for 4 to 6 weeks. This initial phase protects the surgical repair and promotes healing, avoiding active movement of the surgical arm. Patients perform hand, wrist, elbow, and scapular mobility exercises while the shoulder remains immobilized.
The intermediate phase, from weeks 6 to 12, focuses on gradually regaining range of motion. Passive range of motion exercises are introduced first, where the arm is moved by a therapist or the patient’s unaffected arm without engaging surgical muscles. As healing progresses, active assisted and then active range of motion exercises begin. Light isometric strengthening exercises for shoulder muscles may also commence around 8 to 12 weeks post-surgery.
The advanced phase of rehabilitation, from months 3 to 6 and beyond, involves progressive strengthening and a gradual return to activities. Resisted exercises using elastic bands or light weights build muscle strength and endurance. The focus shifts towards sport-specific or activity-specific drills, aiming to restore maximal strength, power, and coordination. Physical therapy guides the patient through all phases, ensuring adherence to precautions for a successful outcome.
Expected Outcomes and Long-Term Results
The ALGR procedure, as an augmented Bankart repair, aims for high success rates in preventing future shoulder dislocations. Arthroscopic Bankart repairs generally show positive outcomes with low re-dislocation rates. Overall, return to sports following arthroscopic shoulder stabilization procedures is often reported above 90%.
Re-dislocation rates after arthroscopic Bankart repair are around 10%. The rate of returning to pre-injury levels of sport can be as high as 91.5%. The time to return to high-demand sports or labor varies, typically ranging from 5 to 8 months, depending on the sport and individual progression through rehabilitation. Athletes in collision sports, such as ice hockey or rugby, may face a higher risk of re-dislocation.