Long-term results of staple capsulorrhaphy for anterior instability of the shoulder.

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.