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The Journal of Bone and Joint Surgery, Vol 75, Issue 2 249-258, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Long-term results of staple capsulorrhaphy for anterior instability of the shoulder
SW O'Driscoll and DC Evans
Upper Extremity Reconstructive Service, St. Michael's Hospital, University of Toronto, Ontario, Canada.
The results of 204 open staple capsulorrhaphies, performed consecutively as
treatment for recurrent anterior instability of the shoulder in 192
patients, were reviewed after an average of ten years (range, two to twenty
years). The operation had been performed for recurrent dislocations in 88
per cent of the shoulders and for recurrent subluxations in the remaining
12 per cent. Postoperative instability--dislocation or
subluxation--occurred in 22 per cent of the shoulders and increased in
frequency logarithmically with the duration of follow-up. In more than half
of these shoulders, the episodes of postoperative instability were
recurrent. In one-third of the shoulders, the stapling had been combined
with a Putti-Platt procedure; in the others, a muscle-splitting approach
had been used. The rate of recurrent instability was 8 per cent in the
shoulders in which a Putti-Platt procedure had been added and 29 per cent
in the shoulders that had been treated by stapling alone. The difference
was significant (p = 0.002). Loosening or migration of a staple, or
penetration of the articular cartilage by a staple, occurred in twenty-four
shoulders (12 per cent); the staple was removed from eighteen of them.
There was no significant difference in the rate of loosening or migration
between non-barbed and barbed staples (p = 0.92). Pain, physical
restrictions, and osteoarthrosis were more frequent in patients who had
complications associated with a staple. Although most of the patients (84
per cent of the shoulders) thought that they had benefited from the
operation, approximately half (51 per cent of the shoulders) had pain and
approximately half (50 per cent of the shoulders) said that the shoulder
was sufficiently different from normal to affect the quality of life.
Problems with the shoulder that had not been present before the operation
caused several patients (5 per cent of the shoulders) to change
occupations. The average ranges of internal and external rotation were
slightly reduced. The subjective and objective results after the stapling
procedure were not as good as previous reports have suggested, and we no
longer recommend staple capsulorrhaphy for anterior instability of the
shoulder, even when it is augmented by a Putti-Platt procedure.
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