Risk Factors for Early Failure After Thermal Capsulorrhaphy
Abstract & Commentary
Synopsis: This paper concludes that previous recurrent dislocations and previous shoulder surgery are 2 risk factors for failure of thermal capsular shrinkage in the treatment of glenohumeral instability.
Source: Anderson K, et al. Am J Sports Med. 2002;30: 103-107.
Glenohumeral instability is a commonly encountered orthopaedic problem in young, active patients. Open stabilization procedures to correct this problem have resulted in high success rates but with some studies showing mild loss of external rotation compared with arthroscopic procedures. A criticism of arthroscopic techniques has been the failure to address capsular laxity adequately, possibly leading to higher failure rates. Thermal capsular shrinkage was developed to arthroscopically address glenohumeral capsular laxity. The use of thermal devices is increasing despite the fact that current clinical and basic science data on thermal shrinkage are limited. The objective of this study was to identify risk factors for poor outcome after thermal capsulorrhaphy.
One hundred six patients with glenohumeral instability were treated with capsular shrinkage alone or with capsular shrinkage plus another procedure. Fifteen patients with treatment failures were identified and different variables analyzed. The mean time to failure after the procedure was 6.3 months. Previous operations and multiple recurrent dislocations were associated with poor outcome at a highly significant level. Multidirectional instability, participation in contact sports, and age did not attain statistical significance as risk factors given the numbers available.
Anderson and colleagues conclude that thermal shrinkage may be more likely to fail in patients who have had prior operations or have a history of multiple dislocations. The data also suggest that thermal capsulorrhaphy should be used cautiously in patients with multidirectional instability or in those who are involved in contact sports.
Comment by William W. Colman, MD
This paper provides additional valuable data in the rapidly growing area of thermal shrinkage. Given the paucity of clinical and basic science data in this area, identifying contraindications is very helpful. However, the follow-up is short and more data will be important to elucidate if further failures occur with time. The failures in this study occurred at a mean of 6 months, which is rapid. Should we expect more failures over time? If previous surgery correlated with failure, then it would be helpful to know if this implies only previous open instability surgery or other types of shoulder surgery? Also, as Anderson et al indicate, there were not sufficient numbers to exclude multidirectional instability, participation in contact sports, or age as risk factors for failure. Further studies with better design, greater numbers, and longer follow-up will help to answer some of these questions.
Dr. Colman, Assistant Professor, Department of Orthopaedic Surgery, UCSF, San Francisco, CA, is Associate Editor of Sports Medicine Reports.