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

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A Letter to the Editor to this article was published on 03 January 2023

Abstract

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.

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Data availability

Data available in a public (general) repository that issues datasets with DOIs.

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Authors and Affiliations

  1. Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India

    Silvampatti Ramasamy Sundararajan, Terence Dsouza & Ramakanth Rajagopalakrishnan

  2. Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India

    Pushpa BT

  3. Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India

    Palanisamy Arumugam

  4. Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India

    Shanmuganathan Rajasekaran

Authors
  1. Silvampatti Ramasamy Sundararajan
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  2. Terence Dsouza
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  3. Ramakanth Rajagopalakrishnan
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Contributions

1. Dr. Silvampatti Ramasamy Sundararajan

Contribution: Conceptualization, Data curation, Formal Analysis, Methodology, Project administration, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review & editing.

2. Dr. Terence Dsouza

Contribution: Conceptualization, Data curation, Formal Analysis, Methodology, Project administration, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review & editing.

3. Dr. Ramakanth Rajagopalakrishnan

Contribution: Conceptualization, Data curation, Formal Analysis, Methodology, Project administration, Supervision, Validation, Visualization, Writing—review & editing.

4. Dr. Pushpa BT

Data curation, Formal Analysis, Methodology, Project administration, Software, Supervision, Writing—review & editing

5. Mr. Palanisamy Arumugam

Data curation, Formal Analysis, Methodology, Project administration.

6. Dr. Shanmuganathan Rajasekaran

Conceptualization, Project administration, Software, Supervision, Validation, Writing—review & editing.

Corresponding author

Correspondence to Silvampatti Ramasamy Sundararajan.

Ethics declarations

Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Institutional review Board(IRB NO. 2O19/11/01).

This Trial was prospectively registered under the Clinical trial registry of India on 13.5.2020. (CTRI/2020/05/025150).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent was taken for publication of patient data.

Conflict of interest

The authors declare no competing interests.

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Sundararajan, S.R., Dsouza, T., Rajagopalakrishnan, R. et al. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder — a prospective randomised study. International Orthopaedics (SICOT) 46, 2593–2601 (2022). https://doi.org/10.1007/s00264-022-05558-z

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