Prospective Evaluation of Thermal Capsulorrhaphy for Shoulder Instability

Abstract

The high rate of unsatisfactory overall results (37%), documented with longer follow-up, is of great concern. The authors conclude that enthusiasm for thermal capsulorrhaphy should be tempered until further studies document its efficacy.

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport

“…Additional evidence of the effect of prior surgery having an effect on revision rates is supported by the level 2 cohort study of 100 athletic shoulders by Bradley et al [8] in which they reported 25% (2 of 8) of their revisions had undergone a prior thermal capsulorrhaphy procedure. Thus, prior surgery resulting in poor quality capsular, especially as a result of thermal shrinkage of capsular tissue may weaken the capsulolabral complex, resulting in unsatisfactory patient outcomes leading to further revision and failure [16] .…”

Arthroscopic Treatment of Shoulder Instability: A Systematic Review of Capsular Plication Versus Thermal Capsulorrhaphy

“…However, only 1 of the 8 study designs used an immobilization period of 6 weeks. 18 Six of the study designs used a 2-to 4-week immobilization period, and the remaining study allowed some patients to discontinue immobilization at 1 week. One study protocol restricted combined movements of abduction with ER, whereas another restricted all passive ROM by a physical therapist or athletic trainer.…”

“…9,12,[15][16][17][18][19][20] In addition to the different types and degrees of instability among the studies, surgical technique varied from a painting style that left no remaining tissue between the treated areas to a striping technique that left minimal tissue between passes. Postoperative management also varied in the period of immobilization and progression of exercises.…”

“…Surgical techniques were not reported and the only postoperative management described was 4 weeks of immobilization. In the other study, 18 patients were grouped as MDI, recurrent or atraumatic anterior subluxation, or traumatic or recurrent anterior dislocation, for a total of 84 shoulders, with 31 failures (37%). Outcomes were reported as excellent in 33 (39%) and good in 20 (24%) based on criteria that included the ability to return to work or sport, recurrent instability, ASES score, and a visual analog scale satisfaction score.…”

“…However, it is important to note that both surgical techniques and postoperative management changed during the study, without the changes being correlated with outcome data. The authors 18 reported changing from a painting technique, in which all tissue was treated, to striping and leaving some untreated tissue between passes owing to concerns about excessive capsular injury. They also changed the rehabilitation protocol because it was initially overaggressive.…”