Arthroscopic shoulder capsulorrhaphy using metal staples.

Staple capsulorrhaphy on the shoulder using a metal staple for traumatic anterior instability has the advantages of increased diagnostic accuracy, microdebridement of the pathology, accurate assessment of the glenohumeral ligament pathology, and selective repair of the ligament pathology. Although the same advantages should apply to staple capsulorrhaphy for traumatic posterior instability, our experience remains very limited. Staple capsulorrhaphy on the shoulder has multiple disadvantages, including being technically difficult with a slow learning curve, not being applicable to all unstable shoulders, an average failure rate of 12% that may be related to inadequate postoperative immobilization, no extra-articular reinforcement, and the use of a metal implant that may need to be removed at a second operation. Staple capsulorrhaphy is currently performed for traumatic anterior instability in the shoulder, with a selected repair of the pathology using a single, well-placed staple and prolonged postoperative immobilization. The design of the staple affords a simpler insertion technique than rivets, screws, and intra-articular sutures. The advent of a biodegradable staple should eliminate inherent problems of metal implants while preserving the advantages of this method.