Abstract
Unidirectional instability with or without hyperlaxity can be adressed as such; mostly traumatic changes like Bankart or capsule lesions are seen and they can be treated with the standard arthroscopic suture techniques.
Multidirectional instability (MDI) with or without hyperlaxity is quite rare. In the literature MDI is often mentioned, but most of the time it refers to multidirectional laxity with unidirectional instability. During arthroscopy often capsular redundancy is seen without obvious pathological changes. Several series have been described where arthroscopic capsulorraphy has shown to be reasonably succesfull Since the introduction of thermal shrinkage several series have been published, with poorer results compared to capsular shift: failure rates vary between 11 to 36%. The possible reason of this high failure rate is that 1) many patients with multi-directional laxity are included, 2) as well as the fact that after time the effect of the shrinkage disappears due to regeneration of the capsule. Posterior instability. In posterior subluxation, often posttraumatic, with hyperlaxity frequently as accompanying phenomenon, arthroscopic capsulorraphy has been rather successful. My personal series of 10 patients showed a failure rate of 50%. Shrinkage has been applied for this indication as well, with varying results. Since 1998 13 patients with posterior subluxations were treated in our hospital with shrinkage after the failure of extensive physical therapy. After 1 yr follow-up most of them were stable; after 18–24 months follow-up all showed recurrence of the posterior instability. The pain, often accompanying the subluxation, was however still absent at the latest follow-up.
Multidirectional instability with or without hyperlaxity is a not well defined clinical entity; for this reason the results of several treatment modalities are often not comparable. Posterior instability, especially subluxations are often posttraumatic, with some accompanying hyperlaxity. In both pathological conditions arthroscopic capsulorraphy seems to be more effective than shrinkage
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
