Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up.
OBJECTIVE
The study goal was to evaluate the arthroscopic treatment of patients with multidirectional instability of the shoulder (MDI). MDI is a disabling condition as a result of pain and restriction of activity. The treatment of MDI is primarily nonsurgical (supervised physiotherapy).


METHODS
Prospective cohort study.


METHODS
Arthroscopic capsular shrinkage, using a bipolar radiofrequency system, was performed in 32 patients (33 shoulders). The mean age was 27 years (range, 15 to 49). The Constant score was used for assessment preoperatively and at 6-month intervals. In 8 patients, labral lesions were revealed at arthroscopy and were addressed using arthroscopic methods.


RESULTS
The follow-up was from 24 to 33 months (26 mean). Patients without labral pathology (group A) and patients with labral lesions (group B) are discussed separately. Group A showed an increase in the mean Constant score at 6 months, but the scores reached a plateau after 6 months. Statistical analysis using 1-way analysis of variance (ANOVA) showed that the mean difference between the preoperative Constant score and the score at latest follow-up was statistically significant (P <.0001; 95% confidence interval, 13.4 to 31.6; standard error, 2.2). The rate of failure or complication was 16%. Three patients experienced recurrence of instability and another developed adhesive capsulitis. Overall, patient satisfaction was 83%. Group B showed an improvement in the Constant scores, and all 8 patients were satisfied. No clinical recurrence of the instability was seen in this group. However, 1 patient developed adhesive capsulitis. This group is too small to draw any statistically valid conclusions.


CONCLUSIONS
The early results are encouraging. Postoperative physiotherapy is of paramount importance. Continued long-term follow-up of this relatively new technique is required to determine the failure rate increase that is likely to occur at longer time intervals.
Frostick
Simon P
SP
Department of Musculoskeletal Science, Royal Liverpool University Hospital, Liverpool, England. S.P.Frostick@liv.ac.uk
Sinopidis
Christos
C
Al Maskari
Sultan
S
Gibson
Jo
J
Kemp
Graham J
GJ
Richmond
John C
JC
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002062:Bursitis / Q000209:etiology; D002358:Cartilage, Articular / Q000293:injuries / Q000601:surgery; D015331:Cohort Studies; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D000078702:Radiofrequency Therapy; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome