Arthroscopic Plication Research Articles

Anterior Capsulorrhaphy: An In Vitro Comparison of Volume Reduction—Arthroscopic Plication Versus Open Capsular Shift

The purpose of this study was to objectively compare volume reduction after arthroscopic plication and open lateral capsular shift. Experimental cadaver study. Fifteen fresh-frozen human cadaver shoulders were assigned to 1 of 2 groups: arthroscopic plication (n = 7) or open lateral capsular shift (n = 8). Initial capsular volume was measured by repeated injection of a viscous fatty acid sulfate solution and recorded for each specimen. Repeated measurements were taken after the procedure to determine volume reduction. Both procedures resulted in reduction of capsular volume. The arthroscopic plication resulted in a 22.8% volume reduction and the open lateral capsular shift resulted in a 49.9% volume reduction. Comparison of the 2 procedures revealed significant volume reduction after open lateral capsular shift compared with arthroscopic plication (P = .00001). Repeated measurements confirmed that the injection technique was valid and reproducible. The lateral capsular shift resulted in significantly greater volume reduction compared with arthroscopic plication. Based on these results, we recommend an open lateral-based capsular shift for patients with multidirectional instability in which a larger capsular shift is required. However, additional plication sutures may allow for an even further reduction in volume. The amount of volume reduction required to eliminate instability still remains unknown for patients with shoulder instability caused by capsular laxity. Level IV Case Series, in vitro anatomic comparison of 2 surgical procedures.

Anterosuperior instability and the rotator interval

An improved understanding of the anatomy of the anterosuperior quadrant of the shoulder and the contributions that these structures make to shoulder stability along with the advances in shoulder arthroscopy have allowed for the recognition and delineation of a number of pathologic conditions. Traumatic avulsion of the superior and/or the middle glenohumeral ligaments can and do occur in the clinical setting, and these capsulolabral disruptions respond very effectively to arthroscopic reconstruction when nonsurgical measures have failed. Another important structure found in the anterosuperior quadrant of the shoulder includes the rotator interval capsule, which has been shown to contribute significantly to stability of the shoulder in both mechanical and clinical studies. Arthroscopic plication of the rotator interval capsule is effective in stabilizing selected cases of shoulder instability and in supplementing other arthroscopic stabilization procedures. This article describes the clinical and arthroscopic findings found with anterosuperior quadrant pathology and provides insights into differentiating pathology from normal variant anatomy. Surgical techniques involved in superior and middle glenohumeral ligament reconstruction as well as arthroscopic rotator interval plication are also described in detail.