Silvampatti Ramasamy Sundararajan1, Terence Dsouza2, Ramakanth Rajagopalakrishnan2, Pushpa Bt3, Palanisamy Arumugam4, Shanmuganathan Rajasekaran5. 1. Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India. sundarbone70@hotmail.com. 2. Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India. 3. Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India. 4. Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India. 5. Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India.
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.
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.
Authors: Dennis Liem; Felix Meier; Lothar Thorwesten; Bjoern Marquardt; Joern Steinbeck; Wolfgang Poetzl Journal: Am J Sports Med Date: 2008-02-13 Impact factor: 6.202
Authors: Amar Rangan; Stephen D Brealey; Ada Keding; Belen Corbacho; Matthew Northgraves; Lucksy Kottam; Lorna Goodchild; Cynthia Srikesavan; Saleema Rex; Charalambos P Charalambous; Nigel Hanchard; Alison Armstrong; Andrew Brooksbank; Andrew Carr; Cushla Cooper; Joseph J Dias; Iona Donnelly; Catherine Hewitt; Sarah E Lamb; Catriona McDaid; Gerry Richardson; Sara Rodgers; Emma Sharp; Sally Spencer; David Torgerson; Francine Toye Journal: Lancet Date: 2020-10-03 Impact factor: 79.321