Arthroscopic Capsulorrhaphy for Multidirectional Instability
What is the History of Surgical Treatment for Multidirectional Instability?
The original description of surgical management for multidirectional instability was provided by Dr. Charles Neer(1), considered by many as a pioneer of many modern shoulder surgery. Dr. Neer’s original description involved an open incision in the front of the shoulder, access to the joint tissue and then cutting and “tucking” the tissue of the capsule back onto itself to eliminate redundancy and tighten the space available for a dislocating humeral head. This procedure was considered as a definitive solution to a dislocating shoulder. This procedure was later refined at many centers, including by Dr. Obermeyer’s mentor in New York City, Dr. Evan Flatow, with very good results(2). In these original series, nearly 90% of patients returned to sports at an average of 5 years of follow-up(2).
The historical open capsular shift operation requires a degree of invasiveness, primarily involving the surgical approach which includes cutting the powerful rotator cuff tendon in the front of the shoulder called the subscapularis. When patients previously treated with an open capsular shift are followed out through the years, there was increasing recognition these patients may have deficits in the integrity of the subscapularis, with a substantial number of patients developing atrophy of the muscle(3). As the decades pass after open instability repair, some of these patients may be at risk of developing pain and dysfunction from a deficient subscapularis muscle-tendon unit.
The strategy behind arthroscopic capsulorrhaphy is to generate the same effect on reducing redundant capsular volume as with an open capsular shift, except without requiring an open incision and without cutting (and then repairing) the subscapularis tendon. The procedure is performed as an outpatient with tiny incisions and is very precise with regard to the intervention at the shoulder capsule without damaging the surrounding tissues.
Arthroscopic capsulorrhaphy is performed with suture anchors, that are very tiny, all suture, and allow tensioning of the capsular tissue in a robust fashion without violating the intact labrum. The effect on reducing capsular volume at the time of arthroscopy is profound when comparing the laxity before and after the repair. With modern technique, excellent results are possible with high rates of return to prior activity and outcomes that are very similar as unidirectional instability(4).
As noted, patients undergoing arthroscopic capsulorrhaphy are discharged the same day in a sling. The procedure is performed with a light general anesthetic and a nerve block which numbs the shoulder. A somewhat delayed rehabilitation protocol is initiated, to ensure proper healing of the tissues occurs, followed by return to full daily activities out of the sling in six weeks. Full activities are resumed at three months following the procedure with return to sport occurring anywhere between four and eight months, depending on the athlete’s demands on the surgical shoulder.
Schedule a shoulder consultation
If you have symptoms consistent with shoulder instability, call our office or book an appointment with shoulder surgeon Dr. Thomas Obermeyer. Dr. Obermeyer specializes in diagnosing and treating shoulder injuries. Dr. Obermeyer has orthopedic offices in Schaumburg, Bartlett, and Elk Grove Village, Illinois. Dr. Obermeyer regularly sees patients from throughout Illinois including Hoffman Estates, Palatine, Elgin, Streamwood, Arlington Heights, and Roselle communities.
References:
- Neer CS 2nd, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am. 1980 Sep;62(6):897-908. PMID: 7430177.
- Pollock RG, Owens JM, Flatow EL, Bigliani LU. Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am. 2000 Jul;82-A(7):919-28. doi: 10.2106/00004623-200007000-00003. PMID: 10901306.
- Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P. Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med. 2006 Oct;34(10):1586-93. doi: 10.1177/0363546506288852. Epub 2006 Jun 26. PMID: 16801689.
- Mitchell BC, Siow MY, Carroll AN, Pennock AT, Edmonds EW. Clinical Outcomes, Survivorship, and Return to Sport After Arthroscopic Capsular Repair With Suture Anchors for Adolescent Multidirectional Shoulder Instability: Results at 6-Year Follow-up. Orthop J Sports Med. 2021 Feb 22;9(2):2325967121993879. doi: 10.1177/2325967121993879. PMID: 33748302; PMCID: PMC7903833.
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Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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