ARTHROSCOPIC CAPSULAR SHRINKAGE FOR MULTIDIRECTIONAL SHOULDER INSTABILITY – THE LEICESTER EXPERIENCE

Abstract

We undertook this study to evaluate our results of Arthroscopic Capsular Shrinkage as a treatment of Multi Directional Instability of the shoulder. Patients with symptomatic multidirectional instability (MDI) have excess capsular laxity. Arthroscopic capsular shrinkage is a fairly new procedure, to treat laxity with variable results in the reported literature. We analysed the records of patients who under went 20 (10 males, nine females) arthroscopic thermal capsular shrinkage procedures for MDI of the shoulder, which were performed by the senior author between 2000 and 2004. The mean age was 28.3 years (median 29.4, range 18 to 46 years) and the mean follow up was 44.5 months (median 43, range 20 to 69 months). All patients had undergone specialist shoulder physiotherapy for four months or more prior to surgery. The type of shoulder instability was subcategorised (based upon the predominant symptomatology as perceived by the patient) as follows: dislocation (seven), subluxation +/− pain (nine), and impingement (four). The procedure and postoperative regimen were standardised. Clinical outcome measures were: patient satisfaction, pain and instability. Sixteen shoulders (80%) were symptom free and fully satisfied at last follow up. One patient (5%) had some pain but a stable shoulder. Three patients (15%) [two dislocators and one subluxator] had recurrent instability between six to eight months post operatively and underwent further surgery. The less the instability, the more likely it was, that the procedure would succeed. We conclude that out results are encouraging particularly in patients with less severe instability despite the small size (20) of our cohort of patients. We think that careful patient selection may be important for success from this surgery.