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Open capsular shift and arthroscopic capsular plication for treatment of multidirectional instability
Mark E Jacobson1, Michael Riggenbach, Adam N Wooldridge
1Division of Shoulder Surgery, Department of Orthopaedics, The Ohio State University, Columbus, Ohio 43221, USA.
Summary
Open inferior capsular shift and arthroscopic capsular plication show similar outcomes for shoulder instability. Both surgical techniques are safe, with comparable results in recurrent instability, range of motion, and complication rates.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Instability Research
Background:
- Multidirectional instability (MDI) of the shoulder is a complex condition often requiring surgical intervention.
- Surgical options for MDI without a Bankart lesion include open inferior capsular shift and arthroscopic capsular plication.
- Comparing the efficacy and safety of these two surgical approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the clinical outcomes of open inferior capsular shift versus arthroscopic capsular plication for treating multidirectional shoulder instability.
- To evaluate differences in recurrent instability, range of motion, return to sport, and complication rates between the two surgical methods.
- To test the hypothesis that there are no significant differences in specific clinical outcomes between open and arthroscopic procedures for MDI.
Main Methods:
- A systematic literature review was conducted using major databases (PubMed, Cochrane, CINAHL, SPORTDiscus) up to 2010.
- Inclusion criteria focused on English-language studies of human subjects addressing open capsular shift and arthroscopic capsular plication for MDI without Bankart lesions.
- Seven relevant articles, encompassing 197 patients and 219 shoulders, were included in the analysis.
Main Results:
- The literature review did not demonstrate clear superiority of open over arthroscopic treatment for MDI.
- Both techniques showed comparable outcomes regarding external rotation loss (no study reported >40° loss) and overall complication rates.
- A slight trend towards improved return to sport was observed with arthroscopic plication, though variability in reporting limited definitive conclusions.
Conclusions:
- Arthroscopic capsular plication offers comparable results to open capsular shift for patients with multidirectional shoulder instability without structural lesions.
- Both surgical approaches are considered safe and effective, yielding similar rates of recurrent instability, return to sport, and complications.
- The choice between open and arthroscopic techniques may depend on surgeon preference and specific patient factors, given the comparable outcomes.
