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Revision Surgery for Failed Thermal Capsulorrhaphy

Hyung Bin Park, MD^*, Atsushi Yokota, MD, PhD, Harpreet S. Gill, MD, George El Rassi, MD and Edward G. McFarland, MD^,

From ^* Gyeong Sang National University, Chinju, South Korea, and the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland

Address correspondence to Edward G. McFarland, MD, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A672, Baltimore, MD 21224-2780 (e-mail: ehenze1{at}jhmi.edu).

Background: With the failure of thermal capsulorrhaphy for shoulder instability, there have been concerns with capsular thinning and capsular necrosis affecting revision surgery.

Purpose: To report the findings at revision surgery for failed thermal capsulorrhaphy and to evaluate the technical effects on subsequent revision capsular plication.

Study Design: Case series; Level of evidence, 4.

Methods: Fourteen patients underwent arthroscopic evaluation and open reconstruction for a failed thermal capsulorrhaphy. The cause of the failure, the quality of the capsule, and the ability to suture the capsule were recorded. The patients were evaluated at follow-up for failure, which was defined as recurrent subluxations or dislocations.

Results: The origin of the instability was traumatic (n = 6) or atraumatic (n = 8). At revision surgery in the traumatic group, 4 patients sustained failure of the Bankart repair with capsular laxity, and the others experienced capsular laxity alone. In the atraumatic group, all patients experienced capsular laxity as the cause of failure. Of the 14 patients, the capsule quality was judged to be thin in 5 patients and ablated in 1 patient. A glenoid-based capsular shift could be accomplished in all 14 patients. At follow-up (mean, 35.4 months; range, 22 to 48 months), 1 patient underwent revision surgery and 1 patient had a subluxation, resulting in a failure rate of 14%.

Conclusions: Recurrent capsular laxity after failed thermal capsular shrinkage is common and frequently associated with capsular thinning. In most instances, the capsule quality does not appear to technically affect the revision procedure.

Key Words: shoulder instability • thermal devices • shoulder surgery • capsule