Prospective evaluation of thermal capsulorrhaphy for shoulder instability: indications and results, two- to five-year follow-up.

Abstract

Thermal shrinkage of capsular tissue has recently been proposed as a means to address the capsular redundancy associated with shoulder instability. Although this procedure has become very popular, minimal peer-reviewed literature is available to justify its widespread use. To prospectively evaluate the efficacy of arthroscopic electrothermal capsulorrhaphy for the treatment of shoulder instability. This nonrandomized prospective study evaluated the indications and results of thermal capsulorrhaphy in 84 shoulders with an average follow-up of 38 months. Patients were divided into three clinical subgroups: traumatic anterior dislocation (acute or recurrent), recurrent anterior anterior/inferior subluxation without prior dislocation, and multidirectional instability. Patients underwent arthroscopic thermal capsulorrhaphy after initial assessment, radiographs, and failure of a minimum of 3 months of nonoperative rehabilitation. Outcome measures included pain, recurrent instability, return to work/sports, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment score. Overall results were excellent in 33 participants (39%), satisfactory in 20 (24%), and unsatisfactory in 31 (37%). 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.