Abstract
Introduction: Thermal shrinkage represents a major innovation in the evolving field of surgery for shoulder instability. The basic science of collagen fiber change has been studied in detailed and set the physical basis for mechanical properties change of the capsule. Animal models and clinical studies has been published for the last decade with short and mid-term results. A clinical application has proceeded basic knowledge in many respects and there is concern about the safety and efficacy of the procedure.
Materials and Methods: Between February 1999 and January 2001, 25 patients, mean age 21.5 (range 16–28) were operated (single shoulder) for radiofrequency capsular shrinkage with VAPR device. In this group 2 high performance sportsmen (basketball and judo), 4 leisure sports activities (mainly basketball), 6 combat soldiers and 13 non related to sporting activities. In 5 of these patients arthroscopic Bankart repair was performed. In one case the procedure was performed after failure of capsular shift in an extreme hyperlax multidirectional instability and this patients was excluded from the study.
Indication for surgery were: 1. Multidirectional instability with less than 3 frank dislocation. 2. Symptomatic subluxators with positive apprehension test after failed non-operative rehabilitation program. 3. High demands first dislocators sportsman with failure of non operative rehabilitation program.
The arthroscopy was performed in sitting position with posterior and anterior portals as a day surgery or overnight hospitalization. Anterior portal was used for VAPR probe first and portals were switched if needed.
All patients were immobilized in shoulder immobilizer for 6 weeks. Rehabilitation program was planed on individual basis and patients were instructed not to return to full contact sport or activities at least 6 months post operatively. Patients were checked at 2 and 6 weeks before commence rehabilitation and than at 3, 6, 24 months. Mean follow up was 17.6 months (range 6–27 m.).
Results: Operation and postoperative course was uneventful and no complications were detected. All patients had normal axillary nerve sensation and normal deltoid function. 21 of 24 (87.5%) regain pre dislocation activity between 6 to 12 months and had no dislocation or instability symptoms. Range of motion after 6 months was fully functional and comparable with the opposite side in 22 of these 23 patients. One patient had postoperative stiffness up to 12 months from operation and recover completely then. All but two followed rehabilitation instructions One of these two regains basketball activities 4 weeks postoperatively and dislocated his shoulder immediately. These patients underwent inferior capsular shift operation later on.
The second patient, a 16 years female elite judoka, commenced judo matches after 3 months and was asymptomatic with 24 months follow-up time.
Conclusion: In selective indications with multidirectional instability, individual rehabilitation program and good cooperation success rate of 91% could be achieved among mixed activities group. We think that this procedure is a good alternative in selected cases. Longer follow-up for selected groups is still needed.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
