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.
1. Abrams JS: Thermal capsulorrhaphy for instability of the shoulder: Concerns and applications of the heat probe. AAOS Instructional Course Lectures50: 29-36, 2001
2.
2. Altchek D, Warren RF, Skyhar MJ, et al: T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am73: 105-112, 1991
3.
3. Anderson K, Warren RF, Altchek DW, et al: Risk factors for early failure after thermal capsulorrhaphy. Am J Sports Med30(1): 103-107, 2002
4.
4. Arnoczky SP, Aksan MS: Thermal modification of connective tissues. J Amer Acad of Ortho Surg8: 305-313, 2000
5.
5. Bigliani LU, Pollock RG, Owens JM, et al: The inferior capsular shift procedure for multidirectional instability of the shoulder. Orthop Trans17: 576-576, 1993
6.
6. Chen SS, Wright NT, Humphrey JD: Heat-induced changes in the mechanics of a collagenous tissue: Isothermal, isotonic shrinkage. J Biomech Eng120: 382-388, 1998
7.
7. Cole BJ, Warner JP: Arthroscopic versus open Bankart repair or traumatic anterior shoulder instability. Clin Sprts Med19: 19-48, 2000
8.
8. Cooper RA, Brems JJ: The inferior capsular-shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg74: 1516-1521, 1992
9.
9. Fanton GS, Khan AM: Monopolar radiofrequency energy for arthroscopic treatment of shoulder instability in the athlete [Review]. Ortho Clin North Am32(3): 511-523, 2001
10.
10. Fitzgerald BT, Watson BT, Lapoint JM: The use of thermal capsulorrphaphy in the treatment of multidirectional instability. J Shoulder Elbow Surg11(2): 108-113, 2002
11.
11. Frostick SP, Sinopidis C, Maskari SA, et al: Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up. Arthroscopy19(3): 227-233, 2003
12.
12. Gartsman G, Taverna E, Hammerman S: Arthroscopic rotator interval repair in glenohumeral instability: Description of an operative approach. Arthroscopy15: 330-332, 1999
13.
13. Gartsman GM, Roddey TS, Hammerman SM: Arthroscopic treatment of anterior-inferior glenohumeral instability. J Bone Joint Surg82A: 991-1003, 2000
14.
14. Gartsman GM, Roddey TS, Hammerman SM: Arthroscopic treatment of multidirectional glenohumeral instability: 2 to 5 year follow-up. Arthroscopy17: 236-243, 2001
15.
15. Gartsman GM, Roddey RS, Hammerman SM: Arthroscopic treatment of bi-directional glenohumeral instability: Two to five-year follow-up. J Shoulder Elbow Surg10: 28-36, 2001
16.
16. Geiger DF, Hurley JA, Tovey JA, et al: Results of arthroscopic versus open Bankart suture repair. CORR337: 111-117, 1997
17.
17. Green M, Christensen K: Arthroscopic versus open Bankart procedures: A comparison of early morbidity and complications. Arthroscopy9: 371-374, 1993
18.
18. Greis PE, Burts RT, Schickendantz MS, et al: Axillary nerve injury after thermal capsule shrinkage of the shoulder. J Shoulder Elbow Surg10: 231-235, 2001
19.
19. Griffin JR, Annunziata CC, Bradley JP: Thermal capsulorrhaphy for instability of the shoulder: Multidirectional and posterior instabilities. AAOS Instructional Course Lectures50: 23-28, 2001
20.
20. Gryler EC, Greis PE, Burks RT, et al: Axillary nerve temperatures during radiofrequency capsulorrhaphy of the shoulder. Arthroscopy17(6): 567-572, 2001
21.
21. Guanche C, Quick D, Sodergren K, et al: Arthroscopic versus open reconstruction of the shoulder with isolated Bankart lesions. Am J Sports Med24: 144-148, 1996
22.
22. Hayashi K, Markel MD, Thabit G III, et al: The effect of nonablative laser energy on joint capsular properties: An in vitro mechanical study using a rabbit model. Am J Sports Med25: 482-487, 1995
23.
23. Hayashi K, Thabit G III, Bogdanske JJ, et al: The effect of nonablative laser energy on the ultrastructure of joint capsular collagen. Arthroscopy12: 474-481, 1996
24.
24. Hayashi K, Thabit G III, Massa KL, et al: The effect of thermal heating on the length and histologic properties of the glenohumeral joint capsule. Am J Sports Med25: 107-112, 1997
25.
25. Karlsson J, Magnusson L, Ejerhed L, et al: Comparison of open and arthroscopic stabilization for recurrent shoulder dislocation in patients with a Bankart lesion. Am J Sports Med29: 538-542, 2001
26.
26. Khan AM, Fanton GS: Arthroscopic capsulorrhaphy for recurrent instability in the athlete. Sports Med and Arthro Rev8: 239-250, 2000
27.
27. Krishnan SG, Hawkins RJ, Kara SG, et al: Electrothermal arthroscopic shoulder capsulorrhaphy: A minimum two year follow-up. Final Program: American Orthopaedic Society for Sports Medicine Annual Meeting (Abstract), p. 101-101, 2002
28.
28. Levine WN, Connor PM: Traditional versus thermal techniques of arthroscopic stabilization. Curr Opin Orthop9(4): 80-94, 1998
29.
29. Levitz CL, Dugas J, Andrews JR: The use of arthroscopic thermal capsulorrhaphy to treat internal impingement in baseball players. Arthroscopy17(6): 573-577, 2001
30.
30. Levy O, Wilson M, Williams H, et al: Thermal capsular shrinkage for shoulder instability: Mid-term longitudinal outcome study. J Bone Joint Surg Br83(5): 640-645, 2001
31.
31. Lopez MJ, Hayashi K, Fanton GS, et al: The effect of radiofrequency energy on the ultrastructure of joint capsular collagen. Arthroscopy14: 495-501, 1998
32.
32. Lyons TR, Griffith PL, Savoie FH III, et al: Laser-assisted capsulorrhaphy for multidirectional instability of the shoulder. Arthroscopy17: 25-30, 2001
33.
33. McFarland EG, Kim TK, Banchasuek P, et al: Histologic evaluation of the shoulder capsule in normal shoulders, unstable shoulders, and after failed thermal capsulorrhaphy. Am J Sports Med30(5): 636-642, 2002
34.
34. Miniaci A, McBirnie J, Miniaci SL: Thermal capsulorrhaphy for the treatment of multi-directional instability of the shoulder. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, Keystone, Colorado, June 2001
35.
35. Mishra DK, Fanton GS: Two-year outcome of arthroscopic Bankart repair and electrothermal-assisted capsulorrhaphy for recurrent traumatic anterior shoulder instability. Arthroscopy17(8): 844-849, 2001
36.
36. Mologne TS, McBride MT, Lapoint JM, et al: Assessment of failed arthroscopic anterior labral repairs: Findings at open surgery. Am J Sports Med25: 813-817, 1997
37.
37. Naseef GS III, Foster TE, Trauner K, et al: The thermal properties of bovine joint capsule: The basic science of laser- and radiofrequencyinduced capsular shrinkage. Am J Sports Med25: 670-674, 1997
38.
38. Neer CS, Foster CR: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: A preliminary report. J Bone Joint Surg62: 897-908, 1980
39.
39. Obrzut SL, Hecht P, Hayashi K, et al: The effect of radiofrequency energy on the length and temperature properties of the glenohumeral joint capsule. Arthroscopy14: 395-400, 1998
40.
40. Rath E, Richmond JC. Capsular disruption as a complication of thermal alteration of the glenohumeral capsule. Arthroscopy17(3): E10-E10, 2001
41.
41. King GJ, Richards RR, Zuckerman JD, et al: A standardized method for the assessment of elbow function. J Shoulder Elbow Surg3: 347-352, 1994
42.
42. Sandusky MD, Schulz MM, McMahon PJ, et al: The effects of laser on joint capsular tissue: An in vivo rabbit study. Trans Ortoph Res Soc24: 355-355, 1999
43.
43. Savoie FH, Field LD: Thermal versus suture treatment of symptomatic capsular laxity. Clin Sprts Med19: 63-75, 2000
44.
44. Schaefer SL, Clarelli MJ, Arnoczky SP, et al: Tissue shrinkage with the holmium:yttrium aluminum garnet laser: A postoperative assessment of tissue length, stiffness and structure. Am J Sports Med25: 841-848, 1997
45.
45. Selecky MT, Vangsness CT Jr, Liao WL, et al: The effects of laserinduced collagen shortening on the biomechanical properties of the inferior glenohumeral ligament complex. Am J Sports Med27: 168-172, 1999
46.
46. Speer KP, Warren RF, Pagnani M, et al: An arthroscopic technique for anterior stabilization of the shoulder with a bioabsorbable tack. J Bone Joint Surg78A: 1801-1807, 1996
47.
47. Speer KP, Deng X, Borrero S, et al: Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg76A: 1819-1826, 1994
48.
48. Sperling JW, Anderson K, McCarty EC, et al: Thermal Shrinkage: Indications and surgical technique. Sports Med Arthrosc Rev8: 260-264, 2000
49.
49. Thabit G III: The arthroscopically assisted holmium YAG laser surgery in the shoulder. Oper Tech Sports Med6: 131-138, 1998
50.
50. Thabit G, Thorpe W, Horne R, et al: Treatment of unidirectional and multidirectional glenohumeral instability by an arthroscopic holmium: YAG laser-assisted capsular shift procedure. Presented at the First Congress of the International Musculoskeletal Laser Society, Fourth Annual Meeting of the California Orthopaedic Association, Squaw Valley, California, May 1994
51.
51. Toth AP, Cordasco FA, Altchek DW, et al: Thermal assisted capsular shrinkage for shoulder instability: Minimum two year follow-up. Final Program: American Orthopaedic Society for Sports Medicine Annual Meeting (Abstract), p. 100-100, 2002
52.
52. Uno A, Bain GI, Mehta JA: Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study. J Shoulder Elbow Surg8: 226-230, 1999
53.
53. Vangsness CT Jr, Mitchell W III, Nimni M, et al: Collagen shortening: An experimental approach with heat. Clin Orthop337: 267-271, 1997
54.
54. Walch G, Boileau P, Noel E, et al: Impingement of the deep surface of the supraspinatus tendon on the posterior glenoid rim: An arthroscopic study. J Shoulder Elbow Surg1: 238-245, 1992
55.
55. Wong KL, Williams GR: Complications of thermal capsulorrhaphy of the shoulder. J Bone Joint Surg Am83(Suppl Pt 2): 151-155, 2001.
