Arthroscopic Capsular Release Provides Greater Range-of-Motion Improvement Within the First 6 Months Postoperatively Than Nonoperative Management Modalities in Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

Purpose: To evaluate the comparative efficacy and safety of arthroscopic capsular release (ACR) compared with nonoperative management modality for frozen shoulder.

Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang databases was conducted to identify randomized controlled trials comparing ACR with nonoperative management modalities for frozen shoulder. Two reviewers independently performed study selection, data extraction, and quality assessment. Outcomes included shoulder pain assessed using the visual analog scale, shoulder function, range of motion, and complications.

Results: The analysis included 6 randomized controlled trials encompassing 705 patients. Evidence of very low to moderate certainty indicated that, within the first 6 months postoperatively, although the improvement in shoulder range of motion with ACR reached the minimal clinically important difference, the magnitude of this improvement diminished over time. Regarding pain, a statistically significant but not clinically meaningful improvement was observed at 6 months postoperatively; no significant improvement was found during other follow-up periods. Safety profiles were comparable between both treatment approaches.

Conclusions: The evidence suggests that ACR may offer superior improvements in shoulder range of motion within the first 6 months postoperatively compared with nonoperative management, but the evidence quality is very low to moderate, primarily because of significant heterogeneity and methodological limitations.

Level of evidence: Level I, systematic review of Level I studies.