Arthroscopic circumferential capsular plication, rotator interval closure and radiofrequency capsulorrhaphy
The surgery is called as Circumferential capsular plication, rotator interval closure and radiofrequency capsulorrhaphy. This is done as an arthroscopic procedure through two or three tiny stab incision.
Steps of the Surgery
Arthroscopic surgery is done after anaesthetising. Two or three tiny stab incision of less than 1cm are made around the shoulder joint. The shoulder joint is thoroughly visualised and the diagnosis of lax capsule in the shoulder joint is confirmed. One could find capsule as a hammock in the front, down and back of the shoulder joint if it is lax.
With the help of a special arthroscopic needle two or three stitches are applied in the anterior (front) capsule of the shoulder joint. Another stitch is applied in the inferior part of the shoulder capsule. Further may be one or two stitch is applied around the posterior aspect of the shoulder capsule.
Rotator interval is a space in the front of the shoulder joint, which is not covered by muscle. This gap is also inherently lax in those who suffer from multidirectional instability; hence this rotator interval is closed with one or two stitches. All these stitches are applied through the arthroscopic stab incisions.
After doing multiple stitches, the capsule is shrunk with the help of radiofrequency probe. The radiofrequency probe emanates radiofrequency waves. This generates heat that is adequate enough to shrink the collagen present in the capsule.
The incisions in the skin are closed with small stitches.
A sling will be given for comfort for a period of 4 – 6 weeks. The movements are encouraged after 6 weeks to get to full function. A systematic physiotherapy programme will be initiated until the satisfactory function is achieved.
The Success rates and the outcomes
The outcome of this procedure is equivocal. But it is worthwhile trying, if other simple modalities of treatment does not help. The reason the surgery has equivocal outcome is because we cant treat the inherent reason for laxity and it is probably gene mediated and it is a general problem that applies to the whole of the human body.
The procedure is safe. The rare complications include infection, stiffness, nerve damage and chondral damage.