Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder — a prospective randomised study,International Orthopaedics

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Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder — a prospective randomised study
International Orthopaedics ( IF 2.0 ) Pub Date : 2022-09-01 , DOI: 10.1007/s00264-022-05558-z
Silvampatti Ramasamy Sundararajan ₁ , Terence Dsouza ₁ , Ramakanth Rajagopalakrishnan ₁ , Pushpa Bt ₂ , Palanisamy Arumugam ₃ , Shanmuganathan Rajasekaran ₄

Affiliation

Purpose

Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures.

Methods

From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis.

Results

Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD.

Conclusion

Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.

中文翻译：

关节镜下囊膜释放与麻醉下手法治疗肩周炎——一项前瞻性随机研究

目的

关节镜下关节囊松解术（ACR）和麻醉下手法操作（MUA）已广泛应用于肩周炎（FS）的治疗。然而，只有有限的一级证据表明 ACR 优于 MUA。我们研究的目的是进行一项随机试验，比较 ACR 与 MUA，以评估两种手术在结果、并发症和成本效益方面的差异。

方法

从 2020 年 5 月到 2021 年 6 月，出现 FS 的患者被随机分为两组 ACR（n = 44）和 MUA（n = 41）。患有关节炎、全层袖带撕裂、外伤史/既往肩部手术史的患者被排除在研究之外。运动范围 (ROM)、使用视觉模拟量表 (VAS) 的疼痛分级、功能评分 - UCLA、CONSTANT 和 EuroQol-5D 评分在术前和术后进行了测量。术后三周进行 MRI 检查以筛查任一手术的并发症。质量调整生命年 (QALY) 用于成本分析。

结果

术后，两组患者的疼痛、ROM 和功能评分均有显着改善（P < 0.001），随访 24 周时组间无显着差异。与非糖尿病患者相比，接受 ACR 的糖尿病患者在外展和外旋方面的改善较小。MUA 组的盂唇撕裂和 ACR 组的骨挫伤是术后 MRI 中最常见的并发症。对于获得的每个 QALY 的 ACR 成本为 896 美元，而 MUA 的成本为 424 美元。