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Thermal capsular necrosis represents a difficult to manage complication of thermal capsulorrhaphy. Most patients present with recurrent instability, and are identified as having large capsular defects at their revision surgery. MRI, CT, and physical examination are unreliable in identifying those individuals who will present with capsular defects. The exact etiology is unclear. While some individuals with thermal capsular necrosis can have the defect sutured either arthroscopically or open, patients with larger defects will require off-site tissue. Appropriate informed consent is necessary in performing revisions of thermal capsulorrhaphy, so that off site tissue can be used if large capsular defects are identified at surgery.