Thermal capsulorrhaphy treatment of shoulder instability - Basic science

Thermal capsulorrhaphy is a new treatment modality for shoulder instability , where the joint capsular tissue is heated and reduced in length by laser or radiofrequency energy to regain joint stability. Experimental studies ha ve shown that (1) joint capsular tissue can be modified significantly (shor tened) by thermal energy at the temperature range of 70 degrees to 80 degre es C; (2) thermal energy causes immediate deleterious effects such as loss of the mechanical properties, collagen denaturation, and cell necrosis; (3) thermally treated tissue is repaired actively by a residual population of fibroblasts and vascular cells, with concomitant improvement of mechanical properties; (4) the shrunken tissue stretches with time if the tissue is su bjected to physiologic loading immediately after surgery; and (5) leaving v iable tissue between treated regions significantly improves the healing pro cess. Therefore, the application of thermal energy to achieve joint stabili ty relies on an initial effect (shrinkage), and to a great extent the tissu e's healing response regain the tissue's mechanical properties. Particularl y, induction of active repair and joint capsular thickening with tissue rem odeling regulated by functional demand seem to be essential factors for a s uccessful outcome. Thermal treatment causes an initial deleterious effect o n the tissue's properties, and overtreatment can lead to severe immediate a nd permanent tissue damage. In addition, scientific data of newly developed devices are limited, and the information from manufacturers often is unrel iable and misleading. Carefully controlled long-term clinical and scientifi c studies should be done to additionally clarify the advantages and disadva ntages of this technique.