Purpose
To compare the results of open inferior capsular shift with arthroscopic capsular
plication for multidirectional instability in patients without a Bankart lesion. We
hypothesized that there is no difference with regard to the specific clinical outcomes
evaluated, including recurrent instability, range of motion, return to sport, and
complications.
Methods
We conducted a comprehensive literature search. Databases searched included PubMed
from 1966 to 2010, the Cochrane Database of Systematic Reviews and Controlled Trials,
CINAHL (Cumulative Index to Nursing and Allied Health Literature) from 1982 to 2010,
and SPORTDiscus from 1975 to 2010. Limits included English language, human subjects,
and title.
Results
We found 7 articles with a total of 197 patients (219 shoulders) that met our inclusion
criteria. The data did not clearly show open treatment to be superior to arthroscopic
treatment. No study reported a consistent loss of greater than 40° of external rotation.
No technique showed significantly less external rotation loss over the other. Whereas
there was a slight trend toward increased return to sport for patients treated arthroscopically,
no clear conclusion can be drawn given the variability of reporting in the reviewed
studies. Analysis of complications shows that both procedures are reliably safe with
minimal complications.
Conclusions
When one is evaluating patients with traumatic or atraumatic onset of shoulder instability
in 2 directions and no structural lesions, arthroscopic capsular plication yields
comparable results to open capsular shift with regard to recurrent instability, return
to sport, loss of external rotation, and overall complications.
Level of Evidence
Level IV, systematic review of Level IV studies.
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Article info
Publication history
Published online: February 27, 2012
Accepted:
December 6,
2011
Received:
September 30,
2011
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
