The Clinical Outcome of Arthroscopic Capsular Release and Debridement for Symptomatic Osteoarthritis of the Shoulder
Authors: Kevin P Shea, Robin Leger
References: Presented at ICSES 2010
Introduction: Arthroscopic capsular release (ACR) is a treatment option for patients with symptomatic osteoarthritis (OA) of the shoulder who do not desire shoulder arthroplasty (TSA). However, there are very few studies that document the outcome of this procedure. Purpose: To prospectively evaluate the outcome of ACR in patients with symptomatic OA.
Methods: Sixteen patients (15 men, 1 woman), average age 56 years (range 41- 73 years) with symptomatic OA and failed conservative treatment were enrolled. Patients were very active did not desire TSA. Pre-operative demographic data, VAS scores for pain, UCLA score and Constant -Murley (CM) scores were obtained. Pre- operative radiographs were scored according to Samilson and Preito (0-4) and Walch (A, B, C). Patients underwent arthroscopic capsular release and removal of loose bodies and immediately started in physical therapy. The humeral surface and osteophytes were not debrided. Patients were contacted a minimum of 18 months after surgery and VAS, UCLA, and CM score were obtained. Satisfaction was evaluated with a yes/no response. Scores were compared using a Student T-test and an ANOVA.
Results: Average time from surgery to follow-up was 28 months (range 18-45 months). Three patients had subsequent TSA. For the remaining 13 patients, the average pre-op VAS was 57, UCLA 14, Constant 39. Average pre-op flexion was 90 and external rotation 0. Average post-op VAS was 26, UCLA 23, and CM 67. All differences were statistically different (p<.05). Average forward flexion improved to 120; average external rotation improved to 55(p<.05).Eleven of 16 patients were satisfied. No correlation between pre-operative radiographs and outcome was identified.
Discussion: The results of this study document that ACR can decrease pain and improve function for patients with symptomatic OA of the shoulder for several years after surgery. Not all patients improve. Pre-operative factors that were predictive of outcome were not identified.