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Arthroscopic Capsular Plication for Atraumatic Shoulder Instability

References: British Elbow and Shoulder Society. Newcastle. 2011

Introduction:
Initial management of atraumatic shoulder instability involves a non-operative approach. f required, advances in arthroscopic surgery have enabled volume reduction through capsular plication. 

Patients and Methods:

Thirty patients underwent arthroscopic capsular plication over a four-year period. Seven patients had previous surgery (thermal capsular shrinkage). All had seen a specialist shoulder therapist and undergone intensive rehabilitation as part of a multidisciplinary team prior to surgery. Oxford Shoulder, Oxford Instability and Quick DASH scores were recorded pre and post-operatively. Overall satisfaction, subjective stability rating and return to work and sport, were also recorded.

Results:
The mean patient age was 30 (range 17 – 45), 20 were female and the mean follow up was 28 months (range 10 – 49). The average length of pre-operative specialist shoulder physiotherapy was 5.8 months (range 1 – 36). 

The Oxford Shoulder Score improved from 24.4 (range 11 – 41) pre-operatively to 39.8 (range 19 - 48) post-operatively; this was statistically significant (p<0.001). The Oxford Instability Score improved from 15.6 (range 4 – 37) to 34.3 (range 11 – 48) (p<0.001). The quick DASH similarly improved from 55.0 (range 22.7 – 93.2) to 17.1 (range 0.0 – 52.5) (p<0.001).

Overall patient satisfaction was 8.6/10 (range 4/10 – 10/10), and overall percentage improvement was 82% (range 50 – 100%).  Five patients had recurrent instability (two traumatic). Twenty-five patients returned to their pre-symptom occupational level and 23 returned to their previous sport. Eighteen of these patients returned to the same pre-symptom level of sporting activity.

Conclusions:

Arthroscopic capsular plication for atraumatic shoulder instability leads to statistically significant improved clinical outcome scores and good overall patient satisfaction.

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