Arthroscopic stabilization plus thermal capsulorrhaphy for anterior instability with and without Bankart lesions: the role of rehabilitation and immobilization.

The use of thermal energy is an exciting new technology in the treatment of anterior instability with and without Bankart reconstruction. The current approach for treating anterior instability in the absence of a Bankart lesion as discussed here is to perform thermal capsular shrinkage with a monopolar RF heat probe to address laxity in the anterior capsule and the inferior glenohumeral ligaments. If a Bankart lesion is present, repair of the lesion with arthroscopic suture anchors followed by thermal capsulorrhaphy is our treatment of choice. We currently reserve open anterior reconstruction for patients with pathology inappropriate for arthroscopic techniques and in cases where arthroscopic suturing is found to be inadequate intraoperatively. Furthermore, patients who require revision and athletes who engage in contact sports are evaluated on an individual basis to ascertain if arthroscopic techniques are appropriate (CD-2.1). Nonetheless, basic science research has revealed the importance of a formal period of immobilization followed by guarded mobilization. By using the aforementioned algorithm and postoperative protocol, low recurrence rates have been achieved while at the same time maintaining motion in the functional range. Of course, further follow-up, more patient studies, and peer review publications are required to determine if thermal capsulorrhaphy can replace open procedures as the gold standard for addressing capsular laxity associated with anterior instability.