Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2‐year follow‐up

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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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