Capsulite rétractile. Traitement chirurgical – Arthrolyse arthroscopique

Abstract

The arthroscopic capsular release appears as an indication of interest in the therapeutic arsenal for treating such difficult pathology as adhesive capsulitis. Today, the surgical technique of arthroscopic capsular release is well codified, even if some points are still debated. It has to be followed by specific, early postoperative physiotherapy to recover range of motion. The results of arthroscopic capsular release are reliable in improving patients, in terms of pain and function with a satisfactory recovery of range of motion, but often incomplete. Diabetes, whether insulin-dependent or not, is a pejorative factor influencing the result. The question that remains widely debated is what is the right moment to propose this surgery during the evolution of adhesive capsulitis. There is no formal answer yet. Depending on the patient's motivation to recover as soon as possible a satisfactory range of motion (e.g., professional reasons), the indication may be proposed when there is either no response to medical treatment or worsening symptoms despite a well-conducted treatment within a reasonable period of time. This does not take in account duration of the disease since its occurence. It seems logical to propose a surgical indication more rapidly to patients with risk factors such as diabetes. On the other hand, it is not logical to limit this indication to refractory patients with severe stiffness resistant to medical treatment after several years of evolution. The result would be limited and disappointing. A compromise is necessary.