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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e3, June 2007

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Fenestration Capsulorraphy for Multidirectional and Posterior Instability (SS-05)

      Purpose

      To present the results of a retrospective study evaluating a new arthroscopic technique for treatment of multidirectional instability.

      Methods

      Medical records were obtained of patients with disabling multidirectional instability requiring arthroscopic stabilization. With a minimum of 24 months follow-up, 45 patients treated from December 1999 to September 2004 were available for review. Of this group, 28 patients (31 shoulders) were able to be contacted for follow-up evaluation. There were 16 male and 12 female patients. Average age was 30.5 years (range 16-52). The arthroscopic technique focuses on reduction of excessive capsular volume. This was accomplished by creating fenestrations in the capsule. The fenestrations were then sutured closed in a pants-over-vest fashion to the adjacent labrum, or side to side in the areas of rotator interval and posterior capsule. Patients were interviewed and assessed via a previously published Subjective Shoulder Score evaluating six categories: pain, strength, function, stability, range-of-motion, and satisfaction.

      Results

      There were 20 excellent, 7 good, 2 fair, and 2 poor results. Two patients had a recurrence of instability. 93.5% of patients were satisfied or very satisfied with their procedure. Adhesive capsulitis occurred in one patient as the only complication.

      Conclusions

      Reducing capsular volume is an important objective in the arthroscopic management of multi-directional instability. Suture plication is widely accepted; however, penetrating multiple layers of capsule and labrum can exceed the limit of suture hooks. Fenestration capsulorrhaphy actually resects a specific amount of redundant capsule, the lateral margin of which is easily advanced and sutured to the abraded labrum. We have shown that this technique restores stability in this difficult subgroup of instability patients whose primary pathology is capsular laxity.