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,*
From the * Shoulder and Elbow Center, Miller Orthopaedic Clinic, Charlotte, North Carolina, and Burke and Bradley Orthopaedics, Pittsburgh, Pennsylvania
Address correspondence and reprint requests to James E. Fleischli, MD, Shoulder and Elbow Center, Sports Medicine Center, Miller Orthopaedic Clinic, 1001 Blythe Blvd., Suite 200, Charlotte, NC 28203.
Background: Thermal shrinkage of capsular tissue has recently been proposed as a means to address the capsular redundancy associated with shoulder instability. Although this procedure has become very popular, minimal peer-reviewed literature is available to justify its widespread use.
Purpose: To prospectively evaluate the efficacy of arthroscopic electrothermal capsulorrhaphy for the treatment of shoulder instability.
Study Design: This nonrandomized prospective study evaluated the indications and results of thermal capsulorrhaphy in 84 shoulders with an average follow-up of 38 months.
Methods: Patients were divided into three clinical subgroups: traumatic anterior dislocation (acute or recurrent), recurrent anterior anterior/inferior subluxation without prior dislocation, and multidirectional instability. Patients underwent arthroscopic thermal capsulorrhaphy after initial assessment, radiographs, and failure of a minimum of 3 months of nonoperative rehabilitation.
Results: Outcome measures included pain, recurrent instability, return to work/sports, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment score. Overall results were excellent in 33 participants (39%), satisfactory in 20 (24%), and unsatisfactory in 31 (37%).
Conclusions: The high rate of unsatisfactory overall results (37%), documented with longer follow-up, is of great concern. The authors conclude that enthusiasm for thermal capsulorrhaphy should be tempered until further studies document its efficacy.
Key Words: arthroscopic surgery • thermal capsulorrhaphy • shoulder instability
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