title: Arthroscopic capsular plication for microtraumatic anterior shoulder instability in overhead athletes.
abstract: BACKGROUND
  Extreme loading conditions at the glenohumeral joint during overhead athletic activities can result in both soft tissue and osseous adaptative changes at the shoulder. Subtle alterations in the stabilizing structures may lead to anterior instability and debilitating shoulder pain with subsequent inability to participate in athletics. There is currently a paucity of data documenting clinical outcomes after arthroscopic capsular plication in overhead athletes who demonstrate objective findings of pain and anterior instability on physical examination.
  
  
  OBJECTIVE
  To evaluate outcomes after arthroscopic capsular plication for anterior instability in overhead athletes with an emphasis on postoperative range of motion, postoperative shoulder function, and return to sport.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The authors identified 20 overhead athletes with debilitating shoulder pain and a failed trial of nonoperative management who underwent arthroscopic capsular plication (12 suture plication, 8 suture anchor plication) for anterior instability related to isolated capsular redundancy. Patients were evaluated with the Single Assessment Numerical Evaluation (SANE) and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, and they were interviewed to determine the rate of return to athletic activity. Failures of treatment included patients who demonstrated debilitating pain that precluded return to sport.
  
  
  RESULTS
  At a mean follow-up of 3.6 years (range, 2.0-5.5 years), 18 (90%) patients returned to overhead sports, with 17 (85%) at their preinjury level. The mean (SD) SANE score was 86 (17.5%; range, 30%-100%), and the mean (SD) KJOC score was 82 (18.2; range, 28-100). When compared with the contralateral extremity, there were no significant differences in glenohumeral range of motion. Two patients with associated rotator cuff injury experienced persistent pain with overhead activity and were unable to return to sport, representing a 10% failure rate.
  
  
  CONCLUSIONS
  Arthroscopic capsular plication for anterior instability related to isolated capsular redundancy is an effective procedure that yields a high rate of patient satisfaction and return to overhead athletic activity with an acceptably low failure rate. Patients with associated rotator cuff injury may be at higher risk for treatment failure.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St, New York, NY 10021, USA. kjjonesmd@gmail.com
authors.forename: Kristofer J
authors.initials: KJ
authors.lastname: Jones
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Kahlenberg
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Dodson
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.forename: Riley J
authors.initials: RJ
authors.lastname: Williams
authors.forename: David W
authors.initials: DW
authors.lastname: Altchek
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000601:surgery*; D001182:Arthroscopy; D001265:Athletic Injuries / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D000070599:Shoulder Injuries; D055815:Young Adult