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Open Capsular Shift and Arthroscopic Capsular Plication for Treatment of Multidirectional Instability

Published:February 27, 2012DOI:https://doi.org/10.1016/j.arthro.2011.12.006

      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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      References

        • Neer II, C.S.
        • Foster C.R.
        Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 1980; 62: 897-908
        • Duncan R.
        • Savoie III, F.H.
        Arthroscopic inferior capsular shift for multidirectional instability of the shoulder: A preliminary report.
        Arthroscopy. 1993; 9: 24-27
        • Kiss J.
        • Damrel D.
        • Mackie A.
        • Neumann L.
        • Wallace W.A.
        Non-operative treatment of multidirectional shoulder instability.
        Int Orthop. 2001; 24: 354-357
        • Burkhead Jr, W.Z.
        • Rockwood Jr, C.A.
        Treatment of instability of the shoulder with an exercise program.
        J Bone Joint Surg Am. 1992; 74: 890-896
        • Misamore G.W.
        • Sallay P.I.
        • Didelot W.
        A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up.
        J Shoulder Elbow Surg. 2005; 14: 466-470
        • Alpert J.M.
        • Verma N.
        • Wysocki R.
        • Yanke A.B.
        • Romeo A.A.
        Arthroscopic treatment of multidirectional shoulder instability with minimum 270 degrees labral repair: Minimum 2-year follow-up.
        Arthroscopy. 2008; 24: 704-711
        • Altchek D.W.
        • Warren R.F.
        • Skyhar M.J.
        • Ortiz G.
        T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types.
        J Bone Joint Surg Am. 1991; 73: 105-112
        • Cooper R.A.
        • Brems J.J.
        The inferior capsular-shift procedure for multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 1992; 74: 1516-1521
        • Gartsman G.M.
        • Roddey T.S.
        • Hammerman S.M.
        Arthroscopic treatment of multidirectional glenohumeral instability: 2- to 5-year follow-up.
        Arthroscopy. 2001; 17: 236-243
        • McIntyre L.F.
        • Caspari R.B.
        • Savoie III, F.H.
        The arthroscopic treatment of multidirectional shoulder instability: Two-year results of a multiple suture technique.
        Arthroscopy. 1997; 13: 418-425
        • Pollock R.G.
        • Owens J.M.
        • Flatow E.L.
        • Bigliani L.U.
        Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 2000; 82: 919-928
        • Caprise Jr, P.A.
        • Sekiya J.K.
        Open and arthroscopic treatment of multidirectional instability of the shoulder.
        Arthroscopy. 2006; 22: 1126-1131
        • Sperling J.W.
        • Cordasco F.A.
        Inferior capsular shift for bidirectional and multidirectional instability.
        Sports Med Arthrosc. 2000; 8: 265-271
        • Setter K.J.
        • Voloshin I.
        • Bigliani L.U.
        The anterior inferior capsular shift.
        Am J Orthop (Belle Mead NJ). 2004; 33: 223-228
        • Pagnani M.J.
        • Warren R.F.
        Multidirectional instability: Medial T-plasty and selective capsular repairs.
        Sports Med Arthrosc. 1993; 1: 249-258
        • Yamaguchi K.
        • Flatow E.L.
        Management of multidirectional instability.
        Clin Sports Med. 1995; 14: 885-902
        • Bigliani L.U.
        • Kurzweil P.R.
        • Schwartzbach C.C.
        • Wolfe I.N.
        • Flatow E.L.
        Inferior capsular shift procedure for anterior-inferior shoulder instability in athletes.
        Am J Sports Med. 1994; 22: 578-584
        • Kim S.H.
        • Kim H.K.
        • Sun J.I.
        • Park J.S.
        • Oh I.
        Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder.
        Am J Sports Med. 2004; 32: 594-607
        • Lebar R.D.
        • Alexander A.H.
        Multidirectional shoulder instability.
        Am J Sports Med. 1992; 20: 193-198
        • Lupo R.
        • Giorgi L.
        • Rapisarda S.
        • Viola E.
        • Pavesi F.C.
        Neer capsular shift surgery in the treatment of recurrent antero-inferior shoulder dislocations.
        Chir Organi Mov. 1999; 84: 153-160
        • Nixon Jr, R.T.
        • Lindenfeld T.N.
        Early rehabilitation after a modified inferior capsular shift procedure for multidirectional instability of the shoulder.
        Orthopedics. 1998; 21: 441-445
        • van Tankeren E.
        • de Waal Malefijt M.C.
        • van Loon C.J.
        Open capsular shift for multi directional shoulder instability.
        Arch Orthop Trauma Surg. 2002; 122: 447-450
        • Voigt C.
        • Schulz A.P.
        • Lill H.
        Arthroscopic treatment of multidirectional glenohumeral instability in young overhead athletes.
        Open Orthop J. 2009; 3: 107-114
        • Massoud S.N.
        • Levy O.
        • Copeland S.A.
        Inferior capsular shift for multidirectional instability following failed laser-assisted capsular shrinkage.
        J Shoulder Elbow Surg. 2002; 11: 305-308
        • Favorito P.J.
        • Langenderfer M.A.
        • Colosimo A.J.
        • Heidt Jr, R.S.
        • Carlonas R.L.
        Arthroscopic laser-assisted capsular shift in the treatment of patients with multidirectional shoulder instability.
        Am J Sports Med. 2002; 30: 322-328
        • Wirth M.A.
        • Groh G.I.
        • Rockwood Jr, C.A.
        Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder.
        J Bone Joint Surg Am. 1998; 80: 1570-1578
        • Yeargan III, S.A.
        • Briggs K.K.
        • Horan M.P.
        • Black A.K.
        • Hawkins R.J.
        Determinants of patient satisfaction following surgery for multidirectional instability.
        Orthopedics. 2008; 31: 647
        • Hamada K.
        • Fukuda H.
        • Nakajima T.
        • Yamada N.
        The inferior capsular shift operation for instability of the shoulder.
        J Bone Joint Surg Br. 1999; 81: 218-225
        • Krishnan S.G.
        • Hawkins R.J.
        • Horan M.P.
        • Dean M.
        • Kim Y.K.
        A soft tissue attempt to stabilize the multiply operated glenohumeral joint with multidirectional instability.
        Clin Orthop Relat Res. 2004; : 256-261
        • Baker III, C.L.
        • Mascarenhas R.
        • Kline A.J.
        • Chhabra A.
        • Pombo M.W.
        • Bradley J.P.
        Arthroscopic treatment of multidirectional shoulder instability in athletes: A retrospective analysis of 2- to 5-year clinical outcomes.
        Am J Sports Med. 2009; 37: 1712-1720
        • Treacy S.H.
        • Savoie III, F.H.
        • Field L.D.
        Arthroscopic treatment of multidirectional instability.
        J Shoulder Elbow Surg. 1999; 8: 345-350
        • Steinbeck J.
        • Jerosch J.
        Surgery for atraumatic anterior-inferior shoulder instability.
        Acta Orthop Scand. 1997; 68: 447-450
        • Wichman M.T.
        • Snyder S.J.
        Arthroscopic capsular plication for multidirectional instability of the shoulder.
        Oper Tech Sport Med. 1997; 5: 238-243
        • Bak K.
        • Spring B.J.
        • Henderson J.P.
        Inferior capsular shift procedure in athletes with multidirectional instability based on isolated capsular and ligamentous redundancy.
        Am J Sports Med. 2000; 28: 466-471
        • Choi C.H.
        • Ogilvie-Harris D.J.
        Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports.
        Br J Sports Med. 2002; 36: 290-294
        • Marquardt B.
        • Pötzl W.
        • Witt K.A.
        • Steinbeck J.
        A modified capsular shift for atraumatic anterior-inferior shoulder instability.
        Am J Sports Med. 2005; 33: 1011-1015
        • Kiss R.M.
        • Illyes A.
        • Kiss J.
        Physiotherapy vs. capsular shift and physiotherapy in multidirectional shoulder joint instability.
        J Electromyogr Kinesiol. 2010; 20: 489-501
        • D'Alessandro D.F.
        • Bradley J.P.
        • Fleischli J.E.
        • Connor P.M.
        Prospective evaluation of electrothermal arthroscopic capsulorrhaphy for shoulder instability: Indications, technique and preliminary results.
        in: Paper presented at the 15th Annual Meeting of the American Shoulder and Elbow Surgeons, New YorkMarch 15, 1998
        • Nottage W.M.
        Laser-assisted shoulder surgery.
        Arthroscopy. 1997; 13: 635-638
        • McFarland E.G.
        • Kim T.K.
        • Park H.B.
        • Neira C.A.
        • Gutierrez M.I.
        The effect of variation in definition on the diagnosis of multidirectional instability of the shoulder.
        J Bone Joint Surg Am. 2003; 85: 2138-2144
        • Thomas S.C.
        • Matsen III, F.A.
        An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability.
        J Bone Joint Surg Am. 1989; 71: 506-513
        • Bell J.E.
        Arthroscopic management of multidirectional instability.
        Orthop Clin North Am. 2010; 41: 357-365
        • Kuhn J.E.
        • Helmer T.T.
        • Dunn W.R.
        • Throckmorton V.T.
        Development and reliability testing of the frequency, etiology, direction, and severity (FEDS) system for classifying glenohumeral instability.
        J Shoulder Elbow Surg. 2011; 20: 548-556
        • Schenk T.J.
        • Brems J.J.
        Multidirectional instability of the shoulder: Pathophysiology, diagnosis, and management.
        J Am Acad Orthop Surg. 1998; 6: 65-72
        • Cohen S.B.
        • Wiley W.
        • Goradia V.K.
        • Pearson S.
        • Miller M.D.
        Anterior capsulorrhaphy: An in vitro comparison of volume reduction—Arthroscopic plication versus open capsular shift.
        Arthroscopy. 2005; 21: 659-664
        • Ponce B.A.
        • Rosenzweig S.D.
        • Thompson K.J.
        • Tokish J.
        Sequential volume reduction with capsular plications: Relationship between cumulative size of plications and volumetric reduction for multidirectional instability of the shoulder.
        Am J Sports Med. 2011; 39: 526-531
        • Flanigan D.C.
        • Forsythe T.
        • Orwin J.
        • Kaplan L.
        Volume analysis of arthroscopic capsular shift.
        Arthroscopy. 2006; 22: 528-533
        • Miller M.D.
        • Larsen K.M.
        • Luke T.
        • Leis H.T.
        • Plancher K.D.
        Anterior capsular shift volume reduction: An in vitro comparison of 3 techniques.
        J Shoulder Elbow Surg. 2003; 12: 350-354
        • Tjoumakaris F.P.
        • Bradley J.P.
        The rationale for an arthroscopic approach to shoulder stabilization.
        Arthroscopy. 2011; 27: 1422-1433