Arthroscopic delivery systems used for thermally induced shoulder capsulorraphy

Surgeons recently used thermal energy to alter the molecular structure of the shoulder capsule to treat patients with shoulder instability. The first reports of thermal treatment of the shoulder capsule used a Holmium:YAG laser set at nonablative settings. Radiofrequency devices have subsequently been developed to deliver thermal energy to the shoulder capsule. Several devices and delivery systems are in current use in North America. These devices share a common final pathway: the delivery of thermal energy to the collagen molecule to disrupt the triple helical structure of collagen. Although each device delivers energy to the capsule, the mechanism of action and the tissue response differs with each device. This article evaluates the current literature regarding these arthroscopic delivery systems, and the response of tissue to the delivery systems.