Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability

Minimum 2-year follow-up

Simon P. Frostick, Christos Sinopidis, Sultan Al Maskari, Jo Gibson, Graham J. Kemp, John C. Richmond

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Purpose: 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). Type of Study: 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.

Original languageEnglish
Pages (from-to)227-233
Number of pages7
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume19
Issue number3
DOIs
Publication statusPublished - Mar 2003

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Bursitis
Therapeutics
Recurrence
Arthroscopy
Patient Satisfaction
Analysis of Variance
Cohort Studies
Prospective Studies
Confidence Intervals
Pathology
Pain

Keywords

  • Bipolar
  • Capsular
  • Instability
  • Multidirectional
  • Shrinkage

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability : Minimum 2-year follow-up. / Frostick, Simon P.; Sinopidis, Christos; Al Maskari, Sultan; Gibson, Jo; Kemp, Graham J.; Richmond, John C.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 19, No. 3, 03.2003, p. 227-233.

Research output: Contribution to journalArticle

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abstract = "Purpose: 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). Type of Study: 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.",
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