Thermal-Assisted Capsular Shrinkage of the Glenohumeral Joint in Overhead Athletes: A 15- to 47-Month Follow-up

Abstract

Study Design: Descriptive postoperative follow-up research. Objectives: The purpose of this investigation was to describe the return-to-competition rate and functional outcome of overhead athletes following arthroscopic thermal-assisted capsular shrinkage (TACS).Background: Traditional open procedures to correct instability in overhead athletes, such as capsulolabral repairs and capsular shifts, have produced less-than-favorable results, which have led to the development of TACS. Currently there are no long-term follow-up studies documenting the efficacy of this procedure in groups greater than 31 subjects or for a time period greater than 27 months. Methods and Measures: Two hundred thirty-one consecutive overhead athletes who due to symptoms of hyperlaxity had previously undergone a TACS procedure from 1997 to 1999 were selected for inclusion in the study. During a 1-month period, 130 of these athletes (mean age ± SD, 24 ± 6 years; 113 male, 17 female) were contacted by phone for follow-up at a mean of 29.3 months postoperatively (range, 15.4-46.6 months). Of the 130, 105 participated in baseball (80 pitchers), 14 in softball, 4 in football (quarterbacks), 4 in tennis, and 3 in swimming. Fifty-four (42%) subjects were professional, 49 (38%) collegiate, 16 (12%) high school, and 11 (8%) recreational athletes. One hundred twenty-three of the 130 (95%) underwent 1 or more concomitant procedure(s) at the time of TACS. Most commonly performed were labral debridements (69%), rotator cuff debridements (65%), and superior labral repairs (35%). Subjects who returned to competition were retrospectively evaluated using a modified Athletic Shoulder Outcome Rating Scale to subjectively assess pain, strength and endurance, stability, intensity, and performance. Overall results were based on a 90-point scale with scores of 80 to 90 representing excellent, 60 to 79 good, 40 to 59 fair, and less than 40 poor results. Results: One hundred thirteen out of 130 subjects (87%) returned to competition. Mean (±SD) time from surgery to return to competition was 8.4 ± 4.6 months. Mean outcome score for all subjects was 79/90; 75 (66%) subjects had excellent, 24 (21%) good, 11 (10%) fair, and 3 (3%) poor result. The mean outcome score for males was 80/90 and for females was 70/90.

Rehabilitation Following Thermal-Assisted Capsular Shrinkage of the Glenohumeral Joint: Current Concepts

“…Our rehabilitation program is based on the clinical experience and outcomes observed in more than 300 patients treated with TACS between 1997 and 1999. 43 Ellenbecker and Mattalino 13 provide an overview of their surgical approach and rehabilitation program for 20 patients with unidirectional shoulder instability who were treated using thermal capsulorrhaphy (capsular shrinkage). The authors note that arthroscopic Bankart repairs and capsular shifts were performed concomitantly on an undocumented number of patients at the time of surgery.…”

Current Concepts in the Recognition and Treatment of Superior Labral (SLAP) Lesions

“…2,3,14,39,45,51,53,65 At our center, Reinold et al 43 reported that 87% of athletes undergoing TACS with concomitant debridement of a SLAP lesion and 84% of athletes with a concomitant SLAP repair returned to competition with good to excellent outcomes using the Modified Athletic Shoulder Outcome Scale.…”

“…Pagnani et al 38 found that a complete lesion of the superior portion of the labrum large enough to destabilize the insertion of the biceps was associated with significant increases in anterior-posterior and superior-inferior glenohumeral translation. Reinold et al 43 reported that in a series of 130 overhead athletes with symptomatic hyper laxity undergoing thermal-assisted capsular shrinkage of the glenohumeral joint (TACS), 69% exhibited superior labral degeneration, while 35% had type II SLAP lesions. Furthermore, Pagnani et al 38 reported that the presence of a simulated SLAP lesion in 7 cadaveric shoulders resulted in a 6-mm increase in anterior glenohumeral translation.…”

“…Andrews et al 3 noted that 83% of 73 throwers exhibited labral lesions when evaluated arthroscopically. Reinold et al 43 noted 91% of overhead athletes undergoing TACS for glenohumeral instability had superior labral pathology of some type.…”

“…7,25,38,43,46,63 Normal biceps function and glenohumeral stability is dependent on a stable superior labrum and biceps anchor. Pagnani et al 38 found that a complete lesion of the superior portion of the labrum large enough to destabilize the insertion of the biceps was associated with significant increases in anterior-posterior and superior-inferior glenohumeral translation.…”