Arthroscopic Capsular Plication Techniques

Abstract

Multidirectional instability is not only difficult to diagnose but to treat as well. The history and physical examination of these patients must be carefully evaluated to make the correct diagnosis. Imaging modalities, such as radiographs and magnetic resonance imaging, are seldom diagnostic but are important to rule out other pathology that may alter a surgeon's course of treatment. Procedures used in the past include a variety of open capsular shift techniques as well as arthroscopic methods. Some of these methods have provided good results but have been associated with a variety of complications as well as poor cosmetic results for the open procedures. This article describes an entirely arthroscopic method of pancapsular plication, which has proven to give excellent results as well as to have a low complication rate. With this arthroscopic pancapsular plication (APCP) technique, it is not only possible to reduce capsular volume but to augment the labrum, which is often flattened and deficient due to either repeated episodes of instability or congenital malformation. Thirty patients treated at our institution utilizing this method were followed for a minimum of 2 years; 97% of these patients were either extremely satisfied or mostly satisfied with the results. We believe that this procedure not only addresses the capsular redundancy and diminished labrum but also offers the advantage of fewer complications compared with open surgical procedures or dangerous arthroscopic procedures, such as thermal capsulorraphy or transglenoid drilling.