Clinical Outcomes of Arthroscopic 360° Capsular Release for Idiopathic Adhesive Capsulitis in the Lateral Decubitus Position

Abstract

To report outcomes after arthroscopic 360° capsular release in the lateral decubitus position for idiopathic glenohumeral adhesive capsulitis without manipulation under anesthesia. A retrospective case series of patients who underwent arthroscopic capsular release in the lateral decubitus position for idiopathic adhesive capsulitis with minimum 2-year follow-up was conducted. Patient demographics, preoperative range of motion (ROM), postoperative ROM, and the postoperative outcome scores, visual analog scale for pain, Single Assessment Numeric Evaluation, Simple Shoulder Test, and American Shoulder and Elbow Surgeons scores, were recorded. Complications and reoperations were recorded. Paired t-tests were used to compare preoperative and postoperative ROM, with P < .05. Overall, 43 patients were identified, of whom 10 were excluded because of post-traumatic etiology. Of the remaining 33 patients, 27 (81.8%) completed a minimum follow-up of 2years. The mean age was 54.8 with a standard deviation of 7.4years and 78% were female, with the duration of symptoms of 16.2 ± 21.0 (range, 3-125) months. Hypothyroidism was present in 7% and diabetes present in 30%. Active forward flexion improved from 115.0° ± 21.9° to 156.2° ± 16.1° at the final follow-up (mean difference, 41.2; 95% confidence interval [33.7, 48.7]; P < .001). Active external rotation with the arm adducted improved from 28.1° ± 16.3° preoperatively to 56.8° ± 15.7° at the final follow-up (mean difference, 27.7; 95% confidence interval [19.1, 36.3]; P < .001). Significant ROM improvements were seen even as early as 2weeks postoperatively (P < .001). Two patients (7%) had manipulation under anesthesia postoperatively due to early recurrent stiffness 4 to 6weeks after arthroscopic capsular release. There were no revision surgeries or complications. Arthroscopic 360° capsular release in the lateral decubitus position for idiopathic adhesive capsulitis results in a significant early and lasting improvement in ROM, excellent functional outcomes, and low revision and complication rates. Level IV, retrospective case series.