Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness

Safiya Erdogan; Seaher Sakha; Ajaykumar Shanmugaraj; Carlos Prada; Rachel M Frank; Timothy Leroux; Moin Khan

doi:10.1177/17585732221092016

Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness

Shoulder Elbow. 2023 Aug;15(4):360-372. doi: 10.1177/17585732221092016. Epub 2022 Apr 5.

Authors

Safiya Erdogan¹, Seaher Sakha², Ajaykumar Shanmugaraj³, Carlos Prada³, Rachel M Frank⁴, Timothy Leroux⁵, Moin Khan^{3

6}

Affiliations

¹ Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
² Faculty of Life Sciences, McMaster University, Hamilton, Ontario, Canada.
³ Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada.
⁴ University of Colorado, Boulder, CO, USA.
⁵ Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Abstract

Purpose: To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder.

Methods: The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes.

Results: Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%).

Conclusion: Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients.

Level of evidence: Level IV, Systematic Review of Level I-IV studies.

Keywords: 360°; adhesive capsulitis; anterior release; arthroscopy; frozen shoulder.

Publication types

Review