Honey, I Shrunk the Joint Capsule

When a joint is unstable, surgeons sometimes tighten the joint by sewing the tissues of the joint capsule together. The joint capsule is a watertight sac that holds fluids that lubricate the joint. Now doctors have another way to tighten the joint capsule. The procedure is done using a laser beam.

A major benefit of using the laser for this surgery is that the surgery can be done using an arthroscope. An arthroscope is a tiny TV camera that is inserted into the joint through a very small incision. This allows the surgeon to watch what he or she is doing on a TV screen during surgery. The small incision allows quicker healing times.

Multidirectional instability (MDI) of the shoulder is a common and serious type of joint instability. In this study, researchers followed up with patients who had been treated for shoulder MDI by using lasers to shrink the joint capsules.

All 26 patients in this study had tried conservative treatments and physical therapy before getting surgery. Because one patient had surgery on both shoulders, the study actually followed 27 surgeries. Of these, 26 were stable and showed no symptoms at least two years after surgery. Fourteen of the patients had been athletes before surgery, and 12 of them were eventually able to return to their sports at the same level.

The authors conclude that laser shrinkage can be an effective treatment for MDI. However, they point out that certain parts of the capsule resist shrinking with the laser. This means that some sutures may still be necessary, even when the laser is used. The authors say that more long-term studies are needed. They are continuing to follow the original patients and plan to report on how these patients are doing four to six years after having surgery.