Thermal Shrinkage as a Treatment of Joint Instability
Thermal shrinkage involves the use of a specialized thermal probe that delivers nonablative heat by radiofrequency or laser energy to a targeted area. The goal is that heat from the thermal probe will alter the collagen fibers of the tissue and cause them to shrink, resulting in a tightening and improved stabilization of the involved joint capsule, ligaments or tendons.
Thermal shrinkage has been proposed for use either alone or in addition to other arthroscopic procedures involving various joints. Thermal shrinkage can involve the joint capsule (e.g., thermal capsulorrhaphy, thermal capsular shrinkage, arthroscopic thermal capsulorrhaphy, electrothermal arthroscopic capsulorrhaphy), ligaments or tendons (e.g., electrothermal therapy, radiofrequency thermal shrinkage).
POLICY
Thermal shrinkage of tendons, ligaments or capsules, either alone or in addition to other arthroscopic procedures, as a treatment of joint instability, including, but not limited to the shoulder, knee, elbow, wrist and ankle, is considered not medically necessary.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
A 2010 review of shoulder instability in individuals with joint hyperlaxity indicates that although initial results with thermal capsulorrhaphy seemed promising, subsequent studies with longer follow-up showed “unacceptably high rates of failure and postoperative complications”, including cases of postoperative axillary nerve palsy and transient deltoid weakness. Abnormal capsular tissue has also been observed in the areas of previous thermal treatment, with either severe thickening or thin, friable deficient capsule. The literature does not support the use of thermal capsulorrhaphy alone, or in combination with other arthroscopic procedures. Therefore, this procedure is considered not medically necessary.
SOURCES
American Academy of Orthopaedic Surgeons. (2007, October). Arthroscopic shoulder surgery: Thermal capsulorrhaphy. Retrieved March, 25 2009 from http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=228&topcategory=Shoulder.
Bahu, M., Trentacosta, N., Vorys, G., Covey, A., & Ahmad, C. (2008). Multidirectional instability: evaluation and treatment options. Clinical Sports Medicine, 27(4), 671 - 678. (Level 5 Evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2010). Thermal capsulorrhaphy as a treatment of joint instability (7.01.82). Retrieved September 27, 2010 from BlueWeb. (22 articles and/or guidelines reviewed)
Bradley,J., Forsythe, B., & Mascarenhas, R. (2008). Arthroscopic management of posterior shoulder instability: diagnosis, indications, and technique. Clinical Sports Medicine, 27 (4), 649 - 670. (Level 5 Evidence)
Chen, S., Haen, P. S., Walton, J., Murrell, G. A. (2005). The effects of thermal capsular shrinkage on the outcomes of arthroscopic stabilization for primary anterior shoulder instability. American Journal of Sports Medicine, 33 (5), 705-711. Abstract retrieved September 27, 2010 from PubMed data base.
Good, C. R., Shindle, M. K., Kelly, B. T., Wanich, T., Warren, R. F. (2007). Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy, 23 (7), 797.e1-5. Abstract retrieved September 27, 2010 from PubMed data base.
Hayes. Medical Technology Directory. (2006, October; last update search October 2009). Thermal Capsulorrhaphy for Shoulder Instability. Retrieved March 25, 2009 from http://www.hayesinc.com/hayes/. (38 articles and/ or guidelines reviewed)
Johnson, S. M., & Robinson, C.M. (2010). Shoulder instability in patients with joint hyperlaxity. The Journal of Bone and Joint Surgery (American volume), 92 (6),1545-1557. Abstract retrieved September 27, 2010 from PubMed data base.
Mason, W. T., & Hargreaves, D. G. (2007). Arthroscopic thermal capsulorrhaphy for palmar midcarpal instability. The Journal of Hand Surgery (European volume), 32 (4), 411-416. Abstract retrieved September 27, 2010 from PubMed data base.
U.S. Food and Drug Administration. (1999, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K991140. Retrieved March 25, 2009 from http://www.fda.gov/cdrh/pdf/k991140.pdf.
U.S. Food and Drug Administration. (2000, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K002402. Retrieved March 25, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K002402.pdf.
U.S. Food and Drug Administration. (2000, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K002422. Retrieved March 25, 2009 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K002422.pdf.
ORIGINAL EFFECTIVE DATE: 5/1/2003
MOST RECENT REVIEW DATE: 3/10/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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