Arthroscopic monopolar radiofrequency thermal capsulorrhaphy for the treatment of shoulder instability: a prospective outcome study with mean 2-year follow-up

Abstract

Purpose: This study describes the experience with arthroscopic monopolar thermal capsulorrhaphy for painful multi-directional shoulder instability in a community-based practice.

Type of study: Prospective outcome study of consecutive patients.

Materials and methods: Thirty-two shoulders in 30 patients were prospectively evaluated using the twelve-question Simple Shoulder Test (SST). This questionnaire assesses shoulder pain and function in a variety of everyday tasks. The duration of symptoms prior to surgery averaged 26.1 +/- 41.0 months (range 2 months-20 years). Patients were evaluated at baseline and then again at various follow-up time points (mean follow-up of 27.7 +/- 8.6 months post-surgery, range, 4-41 months). Patients completed at least 4-6 weeks of physical therapy prior to surgery. All patients were determined to have multi-directional instability during examination under anesthesia and there were no Bankart lesions in the series. When thermal capsulorrhaphy alone was determined to not be adequate to achieve a stable shoulder, the procedure was augmented with additional tuck sutures in whatever direction necessary. Twenty-one of the 32 surgeries (62%) used suture capsulorraphy in addition to the thermal treatment. Following surgery patients were immobilized in a sling for a minimum of 4 weeks and were not allowed to return to sports or strenuous activity until 12 weeks postoperatively.

Results: Mean pre-operative SST score was 5.5 +/- 3.5. Post-operative mean SST score was 9.0 +/- 3.3. This difference was significant (p < 0.0001). Five patients in the series were unable to return to activities of daily living and were considered failures. Two of these patients received a second operation that was then successful.

Conclusions: Arthroscopic monopolar radiofrequency thermal capsulorrhaphy alone in or addition to suture capsular tightening procedures is a successful means of treating patients with painful, symptomatic, multi-directional instability.