Arthroscopic Pancapsular Plication for Multidirectional Shoulder Instability in Overhead Athletes

Abstract

Treating shoulder multidirectional instability with an open stabilization procedure has been reported to have good results. However, few studies exist of arthroscopic plication, especially in overhead athletes. The purpose of this study was to evaluate the clinical outcomes of arthroscopic pancapsular plication for multidirectional instability in overhead athletes.Twenty-three athletes with symptomatic multidirectional instability were treated with arthroscopic pancapsular plication and evaluated at a mean follow-up of 36.3 months (range, 24-61 months). Mean patient age was 23.3 years (range, 19-33 years). Functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and Rowe instability score. The degree of pain and range of motion were also recorded. All postoperative functional scores were rated good to excellent, with an average ASES score of 88.4 (range, 82-95), average Constant shoulder score of 88.1 (range, 81-100), and average Rowe instability score of 86.7 (range, 80-100). Five patients returned to the same level of competitive sports, and 18 returned to a limited level. All patients were satisfied with the stability postoperatively. No significant change was observed in postoperative range of motion, but patients who returned to a limited level of sports had lower functional scores and more pain than did those who fully returned to sports.Arthroscopic pancapsular plication for treating multidirectional instability in overhead athletes can provide good stability. However, the low rate of return to a full level of overhead sports is a problem. Further evaluation of the benefits of this procedure for overhead athletes with symptomatic multidirectional instability is needed.

Atraumatic shoulder instability: pathophysiology clinical assessment and practical management

“…Numerous studies done after that have reported favourablemid term or long term outcomes on functional recovery, various scores and shoulder stability [10,64,65] . Post surgical studies on athletes have reported both positive [66,67] as well as unsatisfactory [68] results on successful return to sporting activities at the top or pre-injury levels. The RI closure also leads to an improvement in both the static and the dynamic restraints which enhances the effect on the shoulder stability and function [69] .…”

Outcomes After Arthroscopic Pancapsular Capsulorrhaphy With Suture Anchors for the Treatment of Multidirectional Glenohumeral Instability in Athletes

“…However, the present study does highlight the fact that patients with a traumatic onset of MDI are more likely to return to sports participation than those whose MDI had an atraumatic onset (83% vs 44%, respectively). Looking specifically at overhead athletes, a recent publication by Ma et al 16 evaluated pancapsular plication for MDI in 25 overhead athletes with a mean age of 23 years (range, 19-33 years) in 17 men and 8 women. All patients reported good-to-excellent results based on ASES, Constant, and Rowe scores.…”

Postoperative Rehabilitation of Multidirectional Instability Surgery: A Systematic Review

“…Savoie and Field 20 had patient's wear slings for 1 to 3 weeks, while other protocols recommended sling wear for 6 weeks. 17,21,24 Similarly, there was no consensus with passive or active range of motion. Witney-Lagen et al 22 and Moon et al 23 initiated passive range of motion via pendulums postoperative day 1 or week 1.…”

“…3,4 In the capsular plication procedure, the glenohumeral ligaments are sutured, decreasing the capsule size. 21,22 These procedures have evolved from an open approach to arthroscopic; some surgeons still opt for open procedures. 2,6…”

“…Others were more conservative, waiting until week 3 18,25 or week 4. 21 Active and active-assisted range of motion also had a wide variety of recommendations. Illyés et al 17 initiated limited active range of motion postoperative day 1, while Ma et al 21 waited until week 6.…”