Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

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PURPOSE: To perform a network meta-analysis of randomized controlled trials in order to determine which interventions optimize clinical outcomes in adhesive capsulitis.

METHODS: A systematic review was conducted of all clinical trials on adhesive capsulitis published since 2008. Patient cohorts were grouped into treatment categories and data collected included range of motion (ROM) and patient-reported outcome measures (PROMs). Interventions were compared across groups by means of arm-based Bayesian network meta-analysis in a random-effects model.

RESULTS: Sixty-six studies comprising 4042 shoulders (57.6% females, mean age 54.8 ± 3.2 years) were included. The most commonly studied interventions were physical therpay (PT) or shoulder injections. Network meta-analysis demonstrated that arthroscopic surgical capsular release was the most effective treatment in increasing ROM - this effect was apparent in forward flexion [effect difference vs. placebo, or ED (95% CI), 44° (31°-58°], abduction [ED 58° (45°-71°)], internal rotation [ED 34° (24°-44°)], and external rotation [ED 59° (37°-80°)]. Interventions most effective for pain relief included PT supplemented with either medical [ED -4.50 (-9.80-2.80)] or ultrasound therapy [ED -5.10 (-5.10- -1.40)]. Interventions most effective for improvement of functional status included PT, manipulation under anaesthesia (MUA), intra-articular or subacromial steroid injection, surgical capsular release, and supplementation of PT with alternative therapy.

CONCLUSIONS: There was not one treatment that emerged superior in regards to range of motion, pain symptoms, and functional status. Surgery, after failure of conservative treatment, ranked highest across all ROM domains. Treatments that ranked highest for treatment of pain included PT supplemented with either medications or ultrasound. Finally, treatments ranked highest for improvements in functional status included MUA, PT with medical therapy, surgical intervention, PT with ultrasound, PT with injection, and injection alone.

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ePub ahead of print