AJSM Click here for details!
HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Sign In to gain access to subscriptions and/or personal tools.
First published on May 9, 2006, doi:10.1177/0363546506287824
This version was published on August 1, 2006
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
34/8/1356    most recent
0363546506287824v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miniaci, A.
Right arrow Articles by Codsi, M. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miniaci, A.
Right arrow Articles by Codsi, M. J.
Related Collections
Right arrow Shoulder
Right arrow Laser/Radiofrequency energy
The American Journal of Sports Medicine 34:1356-1363 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Clinical Sports Medicine Update

Thermal Capsulorrhaphy for the Treatment of Shoulder Instability

Anthony Miniaci, MD, FRCSC* and Michael J. Codsi, MD

From the Cleveland Clinic Foundation, Cleveland, Ohio

* Address correspondence to Anthony Miniaci, MD, FRCSC, Director of Sports Health, Cleveland Clinic Foundation, 9500 Euclid Avenue, A41, Cleveland, OH 44195 (e-mail: miniaca{at}ccf.org).

Thermal capsulorrhaphy has been used to treat many different types of shoulder instability, including multidirectional instability, unidirectional instability, and microinstability in overhead-throwing athletes. A device that delivers laser energy or radiofrequency energy to the capsule tissue causes the collagen to denature and the capsule to shrink. The optimal temperature to achieve the most shrinkage without causing necrosis of the tissue is between 65° and 75° centigrade. This treatment causes a significant decrease in mechanical stiffness for the first 2 weeks, and then, after the tissue undergoes active cellular repair from the surrounding uninjured tissue, the mechanical properties return to near normal by 12 weeks. If the thermal energy is applied in a grid pattern, then the tissue heals with more stiffness by 6 weeks. Clinical studies on thermal capsulorrhaphy for the treatment of multidirectional instability have shown a high rate of recurrent instability (12%–64%). The clinical studies on unidirectional instability showed much better recurrence rates (4%–25%), but because most of the patients also underwent concomitant Bankart repairs and superior labral anterior posterior lesion repairs, the efficacy of the thermal treatment cannot be ascertained. A randomized controlled trial would be needed to assess whether instability with Bankart lesions requires augmentation with thermal capsulorrhaphy. For the patients with microinstability who are overhead-throwing athletes, thermal capsulorrhaphy has shown varying results from a 97% rate of return to sports to a 62% rate of return to sports. Complications of this technique include temporary nerve injuries that usually involve the sensory branch of the axillary nerve and thermal necrosis of the capsule, which is rare.

Key Words: thermal capsulorrhaphy • shoulder instability






HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American Orthopaedic Society for Sports Medicine.