Arthroscopic Capsular Release Versus Manipulation under Anesthesia for Refractory Frozen Shoulder: A Systematic Review with Meta-Analysis.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(21):9 Orthop Surg . 2024 Jul;16(7):1517-1529. doi: 10.1111/os.14077. Epub 2024 May 15.What this means for my practice?
ACR does not significantly outperform MUA in terms of pain relief or functional improvement, yet it poses a higher risk of severe complications. These findings indicate that MUA remains a viable, safer option for refractory FS patients, though ACR may offer minor long-term pain benefits. Limitations include the limited number of long-term follow-ups and small sample sizes across studies, suggesting the need for further research.
Study Summary
This systematic review and meta-analysis included eight studies with 768 patients diagnosed with refractory frozen shoulder, comparing arthroscopic capsular release (ACR) versus manipulation under anesthesia (MUA). The pooled outcomes examined changes in pain (VAS), functional scores (ASES, CMS), range of motion, complication rates, and need for additional interventions. ACR provided statistically better pain relief after 12 months (p = 0.001) but did not meet the minimal clinically important difference. Rates of mild complications were similar between groups, but ACR showed a significantly higher rate of severe complications (p = 0.05).
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