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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Orthop+Surg+Res
2018 ; 13
(1
): 56
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Clinical outcome of arthroscopic capsular release for frozen shoulder: essential
technical points in 255 patients
#MMPMID29548325
Kanbe K
J Orthop Surg Res
2018[Mar]; 13
(1
): 56
PMID29548325
show ga
BACKGROUND: The purpose of this study was to investigate the long-term clinical
outcome and its related factors regarding the severity of adhesion of CH ligament
over long head of biceps (LHB) after shoulder arthroscopic capsular release for
frozen shoulder with technical points in 255 patients. METHODS: We performed
arthroscopic capsular release for frozen shoulder in 267 shoulders of 255
patients, 112 males and 143 females, with mean age of 56.39 years, mean disease
duration periods of 0.934 years for conservative treatment, and mean follow-up
periods of 5.6 years. The frozen shoulders were divided based on the severity of
adhesion between CH ligament over LHB: those with slight degree of synovitis, no
adhesion by obtuse rod, and slight thickness of the released capsule (type A),
those with moderate degree of synovitis, moderate adhesion of the LHB by obtuse
rod, and moderate thickness of the released capsule (type B), and those with
severe degree of synovitis, severe adhesion of the LHB by obtuse rod, and severe
thickness of the released capsule adhesion and a flatly shaped LHB (type C). We
assessed the clinical factors related to the scoring of the shoulders by the
criteria of the American Shoulder and Elbow Surgeons (ASES) and the relationship
with severity of LHB adhesion. RESULTS: The ASES scores improved at 5 years
postoperatively in all three groups significantly. The range of motion also
significantly improved in all three groups significantly. The severity of the LHB
adhesion over the CH ligament was confirmed to influence the ASES scores before
and after the arthroscopic capsular release. There was a significant difference
between type A and type B (p?0.0001) or type C (p?0.0001) before and after
surgery. Logistic regression analysis showed disease duration, diabetes mellitus
(DM), and ASES score were significantly associated to the severity type of LHB,
especially DM has high odds ratio and was a risk factor for LHB adhesion. There
is no adverse event including dislocation or axillary nerve injury and recurrence
after arthroscopic capsular release at 5 years after surgery. CONCLUSIONS: The
long-term results of arthroscopic capsular release in frozen shoulder were
confirmed in 255 patients. The severity of LHB adhesion over the CH ligament, a
pathological condition related to DM as a risk factor, seems to play an important
role in the functional outcome. Therefore, the sufficient release of LHB was
essential technical point for arthroscopic capsular release in frozen shoulder.