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Arthroscopic Pan-Capsular Plication for Multidirectional Instability of the Shoulder
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April 9, 2011
This video shows our updated technique for performing a pancapsular plication. Over the years we ...
read more ↘ have found this to be one of the most reliable and safe of all shoulder arthroscopy procedures. Recently there have been reports in the literature that it might be better to use anchors rather than suturing the capsule to the labrum as we show in this video. We agree that if one uses simple sutures it will likely not be as strong but using figure of 8 stitch pattern. On the other hand, as in all other soft tissue repairs, a figure of 8 stitch gives us a much stronger hold on the labrum as well as the capsule. I have not done any testing on this construct but do know it is my suture of choice for any side to side soft tissue repair as opposed to simple stitches or mattress stitches. I prefer to use the softer polyester suture Ethibond®, rather than the high-strength suture. Also, it's very important to use the strand of suture that is on the capsular side of the fig-8 as the "post"..This will keep the knot away from the articular surface and avoid abrasion on the cartilage of the humeral head. Finally, it is very important to hold the arm in a 15ºER "UltraSling" brace post op and start motion with pendulum and elbow wrist and hand exercises as soon as possible. These patients will feel tight for 4-6 months but seem to get excellent motion and are very grateful. Give it a try and let me know. If anyone out there has access to a biomechanics lab, please consider testing this suture pattern in a cadaver. Thanks Steve and Nirav.
↖ read less
read more ↘ have found this to be one of the most reliable and safe of all shoulder arthroscopy procedures. Recently there have been reports in the literature that it might be better to use anchors rather than suturing the capsule to the labrum as we show in this video. We agree that if one uses simple sutures it will likely not be as strong but using figure of 8 stitch pattern. On the other hand, as in all other soft tissue repairs, a figure of 8 stitch gives us a much stronger hold on the labrum as well as the capsule. I have not done any testing on this construct but do know it is my suture of choice for any side to side soft tissue repair as opposed to simple stitches or mattress stitches. I prefer to use the softer polyester suture Ethibond®, rather than the high-strength suture. Also, it's very important to use the strand of suture that is on the capsular side of the fig-8 as the "post"..This will keep the knot away from the articular surface and avoid abrasion on the cartilage of the humeral head. Finally, it is very important to hold the arm in a 15ºER "UltraSling" brace post op and start motion with pendulum and elbow wrist and hand exercises as soon as possible. These patients will feel tight for 4-6 months but seem to get excellent motion and are very grateful. Give it a try and let me know. If anyone out there has access to a biomechanics lab, please consider testing this suture pattern in a cadaver. Thanks Steve and Nirav.
↖ read less
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