title: Laser capsulorrhaphy for multidirectional instability of the shoulder. An outcomes study and proposed classification system.
abstract: BACKGROUND
  Clinical data on the efficacy of laser capsulorrhaphy for the treatment of multidirectional instability of the shoulder are limited.
  
  
  OBJECTIVE
  The diagnosis of multidirectional instability includes a spectrum of pathologic symptoms that warrants subclassification; laser capsulorrhaphy alone is not uniformly effective for all subtypes.
  
  
  METHODS
  Retrospective review of prospectively collected data.
  
  
  METHODS
  Twenty-five shoulders in 21 patients were treated with laser capsulorrhaphy for multidirectional instability. Functional outcomes at a mean duration of 32 months' follow-up (range, 24 to 48 months) were recorded.
  
  
  RESULTS
  Instability recurred in 60% of patients with congenital multidirectional instability, 17% of patients with acquired multidirectional instability, and 33% of patients with posttraumatic multidirectional instability (overall recurrence rate, 40%). Generalized ligamentous laxity was a risk factor for recurrence. Patient satisfaction rates were 40%, 83%, and 22% for the congenital, acquired, and posttraumatic subgroups. Reasons for dissatisfaction included recurrent instability, persistent pain, and inability to return to athletic activity at desired capacity. The overall mean postoperative Simple Shoulder Test score was 84%. The mean postoperative numeric rating score for pain was 3.3 (10-point scale).
  
  
  CONCLUSIONS
  Laser capsulorrhaphy may be effective for patients with acquired multidirectional instability secondary to repetitive microtrauma but is less predictable in the other subgroups.
authors.affiliation: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland. Humility of Mary Health Partners, Youngstown, Ohio, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Joseph
authors.forename: James S
authors.initials: JS
authors.lastname: Williams
authors.forename: John J
authors.initials: JJ
authors.lastname: Brems
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology / Q000601:surgery*; D004204:Joint Dislocations / Q000209:etiology; D007593:Joint Instability / Q000145:classification* / Q000503:physiopathology / Q000601:surgery*; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000601:surgery; D017060:Patient Satisfaction; D020127:Recovery of Function / Q000502:physiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D013177:Sports / Q000502:physiology; D016896:Treatment Outcome