Thermal capsular shrinkage for shoulder instability

Abstract

We present the short-and medium-term clinical results of thermal shrinkage in selected groups of patients with multidirectional or capsular stretch-type instability. We treated 56 patients (61 shoulders) by laser-assisted capsular shrinkage (LACS) and 34 patients (38 shoulders) by radiofrequency (RF) capsular shrinkage. The two groups were followed for mean periods of 40 months and 23 months, respectively.In the LACS group the mean Walch-Duplay score improved to 90 points 18 months after the operation, but then declined to a plateau of about 80 points; 59% of patients considered their shoulders to be 'much better' or 'better' but there was a failure rate of 36.1%. For the RF group the mean Walch-Duplay and Constant scores were 80 points at the various follow-up times; 76.3% of patients considered their shoulder to be 'much better' or 'better'. RF failed in nine shoulders (23.7%). These results match some clinical series of patients with multidirectional instability, undergoing open inferior capsular shift, with a similar rate of failure. We believe that the minimal morbidity involved makes thermal shrinkage a viable alternative to open capsular shift in this difficult group of patients.

Thermal Shrinkage for Shoulder Instability

“…Initially, it was thought that thermal capsular shrinkage would be particularly useful for MDI because of the ability of this procedure to decrease capsular volume globally. Most authors have found an increased risk of failure with thermal capsular shrinkage for treatment of MDI ranging from 24% to 59% [43] [2,27,57,69]. We noted a failure incidence of 28% (eight of 26) for MDI in our series.…”

“…Outcomes of thermal capsular shrinkage in contact athletes and in shoulders with a history of previous dislocations have been less satisfactory than open and other arthroscopic stabilization procedures for the most part [2,13,16,21,43,61,65,69]. Our results for thermal capsular shrinkage in contact athletes were poor with 31% failure, and in shoulders with a history of previous dislocations, 26% failed.…”

“…Most studies suggest that the most successful outcomes of this procedure occur in patients with mild instability, unidirectional anterior instability, and thermal procedures in combination with arthroscopic suture or tack repairs of the capsule and/or labrum [3, 13, 14, 18-20, 26, 42, 57, 58, 65, 66]. Outcomes of thermal capsular shrinkage in contact athletes and in shoulders with a history of previous dislocations or multidirectional instability have been less satisfactory than open stabilization procedures [2,13,16,18,21,43,57,69,78]. Post-operative rehabilitation program and patient compliance are likely important to outcome [37,77], but are not well studied.…”

Grundlagen radiochirurgischer Systeme und ihre Anwendungen in der Arthroskopie

“…Posttraumatische oder habituelle Instabilitäten von Gelenken sind oft für Patienten und Operateure gleichermaßen ein schwieriges Problem [15,19]. Ins- [19].…”

“…Ins- [19]. Die Rezidivrate ist insgesamt jedoch deutlich höher als die Literaturangaben nach offen-chirurgischem anterioren Kapselshift (10-15%).…”