Fenestration capsulorrhaphy restores stability and gives patient satisfaction

Novel arthroscopic treatment for disabling multidirectional instability had few recurrences.

A new study showed improved stability and low recurrence rates in patients treated for disabling multidirectional instability with a novel arthroscopic technique that creates and then closes fenestrations in the shoulder capsule.

In a minimum 2-year follow-up of 28 patients who underwent fenestration capsulorrhaphy, investigators found a 94% patient satisfaction rate and an Subjective Shoulder Score of 3.9 for stability (out of a maximum score of four). The retrospective study also revealed that 87% of the patients had good or excellent results from the surgery.

"This more aggressive approach produces a cut edge of capsule with an increased bleeding response which should more readily heal to the labrum," E. Rhett Hobgood, MD, said during his presentation at the Arthroscopy Association of North America 26th Annual Meeting. The investigators only found two cases of recurrence out of 31 procedures. "We feel that fenestration capsulorrhaphy effectively reduces capsular volume with a low recurrence rate and a high rate of satisfaction," Hobgood said.

The technique involves creating and then closing fenestrations in the capsule to shorten it and decrease capsular volume. During the procedure, surgeons make fenestrations in the inferior glenohumeral ligament at the 5, 6 and 7 o'clock positions as well as in the posterior capsule and rotator interval. "We used three portals; the posterior inferior portal, anterior superior portal and anterior inferior portal," Hobgood said. "Special attention is given to the posterior portal which is more inferior and lateral than the standard posterior arthroscopic portal."

Surgeons use a shaver to create fenestrations and abrade the adjacent labrum. "The shaver is used to place full-thickness fenestrations roughly 1 cm wide and immediately adjacent to the labrum," Hobgood told Orthopedics Today.

"This produces an aggressive healing response." The suture hook is used to pass a #1 PDS suture through the lateral margin of the fenestration, then through the intact labrum. The suture is tied and effectively closes the lateral margin to the labrum. Then they close the fenestrations in the posterior capsule and rotator interval using a side-to-side technique. "The final product is an appropriately reduced amount of capsular volume and a well-centered humeral head over the glenoid," he said.

The investigators followed the cohort for a minimum of 2 years. "Our results were very good," Hobgood said. "Most impressively, the stability score of 3.9 out of 4 was achieved. We also had a 3.4 out of 4 for satisfaction. This gives us 87% good to excellent results with only two recurrences out of 31 shoulders and a 94% rate of satisfaction in this difficult subgroup of shoulder instability patients."

For more information:
E. Rhett Hobgood, MD, can be reached at Orthopaedic Sportsmed Group, Inc., 3000 California St., San Francisco, CA 94115; 415-292-9528; e-mail: rhobgood@gmail.com. Orthopedics Today was unable to determine whether he has a direct financial interest in the products discussed in this article.

Reference:
Hobgood ER, Wolf EM. Fenestration capsulorrhaphy for multidirectional shoulder instability. SS-05. Presented at the Arthroscopy Association of North America 26th Annual Meeting. April 26-29, 2007. San Francisco.