Prospective Evaluation of Thermal Capsulorrhaphy for Shoulder Instability

Abstract

Background Thermal shrinkage of capsular tissue has recently been proposed as a means to address the capsular redundancyassociated with shoulder instability. Although this procedure has become very popular, minimal peer-reviewed literature isavailable to justify its widespread use. Purpose To prospectively evaluate the efficacy of arthroscopic electrothermal capsulorrhaphy for the treatment of shoulderinstability. Study Design This nonrandomized prospective study evaluated the indications and results of thermal capsulorrhaphy in 84shoulders with an average follow-up of 38 months. Methods Patients were divided into three clinical subgroups: traumatic anterior dislocation (acute or recurrent), recurrent anterioranterior/inferior subluxation without prior dislocation, and multidirectional instability. Patients underwent arthroscopic thermalcapsulorrhaphy 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 ElbowSurgeons (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. Theauthors conclude that enthusiasm for thermal capsulorrhaphy should be tempered until further studies document its efficacy.