Article Text

Download PDFPDF

2 Arthroscopic capsular shift surgery in patients with atraumatic shoulder instability: a randomised placebo-controlled trial
  1. Anju Jaggi1,
  2. Rob Herbert2,
  3. Susan Alexander3,
  4. Addie Majed1,
  5. Will Rudge1,
  6. David Butt1,
  7. Debbie Higgs1,
  8. Karen Ginn4
  1. 1Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
  2. 2NeuRA, Margarete Ainsworth Building Barker Street Randwick NSW 2031, Australia
  3. 3Fortius Clinic, 17 Fitzhardinge Street, UK
  4. 4University of Sydney, School of Medical Sciences, Room E316, Anderson Stuart Building (F13), Australia


Introduction Atraumatic shoulder instability (ASI) occurs in the absence of significant trauma and can impair shoulder function. Arthroscopic capsular shift (ACS) is recommended in persistent symptoms. The primary objective of this trial was to determine the effect of ACS in ASI.

Materials and Methods A single-centre, two-arm, randomized, placebo-controlled clinical trial incorporating concealed intervention assignment, blinded assessment, and analysis by intention-to-treat was conducted. Patients over 18 years, with positive apprehension tests and evidence of capsulo-labral damage on arthroscopy, were eligible for inclusion. Participants were randomised to ACS or arthroscopy only. All patients received the same post-operative care.

The primary outcome was the Western Ontario Shoulder Instability Index (WOSI), a change of 10.4 points was considered to be clinically significant. Secondary outcomes included global perceived change and episodes of dislocations. Patients were followed up at 6, 12 and 24 months.

Results 68 patients, average age 25.6 (SD 6.4), 53 females (77.9%) were randomised into the trial. Complete primary outcome data were available for 61 (90%), 59 (87%) and 56 (82%) at 6, 12 and 24 months respectively.

Mean change on the WOSI scores at 6, 12 and 24 months were 5, 1 and 2 points respectively. Confidence intervals were narrow enough to rule out a clinically worthwhile beneficial effect of ACS at 6 months and the confidence intervals were nearly narrow enough to rule out clinically worthwhile effects at 12 and 24 months.

Conclusion The data suggest that ACS has no additional benefit in management of ASI compared to placebo.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.