Purpose: The purpose of this study was to review the clinical results of laser-assisted thermal capsulorrhaphy in patients with glenohumeral instability.
Type of study: A case series of consecutive patients with shoulder instability treated with laser-assisted thermal capsulorrhaphy by one surgeon.
Methods: From 1994 through 1997, 60 shoulders in 59 patients (27 men, 32 women) with no previous shoulder surgery underwent laser-assisted thermal capsulorrhaphy. The direction of instability was classified as anterior in 30, posterior in 7, anteroposterior in 4, and multidirectional (MDI) in 19. Patients were evaluated on the basis of pain, recurrent instability, function, and satisfaction.
Results: Nine patients were lost to follow-up evaluation, and 9 patients underwent revision surgery (7 MDI, 1 anterior, I posterior). Of the remaining 42 patients, none underwent further surgery; the average follow-up time was 38.4 months (range, 24 to 66 months); and pain scores improved from 7.8 +/- 2.6 (1-10 scale) to 1.7 +/- 2.6. postoperatively. In addition, 86% of patients reported none or rare episodes of instability compared with 37% preoperatively. Painless overhead use of the shoulder improved from 12% to 73%. Scores based on the American Shoulder and Elbow Surgeons (ASES) rating system improved from 61.0 +/- 2.6 to 89.5 +/- 15.0 (P <.05). Patient satisfaction for the remaining 42 patients, on a 1 to 10 scale, averaged 8.0 +/- 2.8.
Conclusions: Based on these results, we conclude that laser-assisted thermal capsulorrhaphy is an effective adjunct in the treatment of anterior and posterior instability. Patients with MDI treated with this technique have high failure rates. We recommend caution when approaching MDI patients with this technique.