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This Article Full Text Full Text (PDF) All Versions of this Article: 35/9/1484    most recent 0363546507301082v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hawkins, R. J. Articles by Horan, M. P. Search for Related Content PubMed PubMed Citation Articles by Hawkins, R. J. Articles by Horan, M. P. Related Collections Shoulder Arthroscopy

Electrothermal Arthroscopic Shoulder Capsulorrhaphy

A Minimum 2-Year Follow-up

Richard J. Hawkins, MD^,*, Sumant G. Krishnan, MD, Spero G. Karas, MD, Thomas J. Noonan, MD^|| and Marilee P. Horan^||

From the Steadman Hawkins Clinic of the Carolinas, Spartanburg, South Carolina, The Carrell Clinic, Dallas, Texas, Emory Healthcare Sports Medicine Center, Atlanta, Georgia, and ^|| Steadman–Hawkins Research Foundation, Vail, Colorado

^* Address correspondence to Richard J. Hawkins, MD, FRCS (C), Attn: Clinical Research, Steadman Hawkins Research Foundation, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.

Background: Few studies have documented the outcomes of thermal capsulorrhaphy for shoulder instability.

Purpose: To examine prospective evaluate outcomes of the first 100 patients with glenohumeral instability treated with thermal capsulorrhaphy.

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

Methods: Between 1997 and 1999, 85 of 100 patients treated with thermal capsulorrhaphy for glenohumeral instability were available for review at 2-year minimum follow-up (average, 4 years). Fifty-one patients suffered from anterior instability; 24 had an associated Bankart lesion. Ten patients demonstrated posterior instability; 1 had an associated reverse Bankart lesion. Seventeen patients had multidirectional instability; 8 had an associated Bankart lesion. Seven patients demonstrated anterior and posterior instability without an inferior component; 2 had an associated Bankart lesion. Failures were defined as shoulders requiring revision stabilization (14) or with recurrent instability (18), recalcitrant pain (3), or stiffness (2).

Results: Forty-eight of 85 procedures were successful, and 37 of 85 failed. For patients with anterior instability plus a Bankart lesion, 7 of 24 (26%) had failed results. For those with anterior instability without a Bankart lesion, 10 of 27 (33%) had failed results. The failure rates for posterior, multidirectional instability, and anteroposterior were 60% (6/10), 59% (10/17), and 57% (4/7), respectively. Of the 48 successes, mean preoperative American Shoulder and Elbow Surgeons score improved from 71 to 96 postoperatively, and patient satisfaction was 9.1 on a 10-point scale.

Conclusion: Because of the high failure rates, we now augment thermal capsulorrhaphy with capsular plication and/or rotator interval closure in cases of posterior and multidirectional instability and have lengthened the initial immobilization period to improve outcomes. Failure rates for thermal capsulorrhaphy, even with labral repairs, are high especially for shoulders with multidirectional instability and posterior instability. When procedures were successful, however, patients were very satisfied with significant improvements in American Shoulder and Elbow Surgeons scores.

Key Words: shoulder instability • arthroscopic shoulder stabilization • thermal capsulorrhaphy • capsular plication • outcomes