Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder?

Abstract

Purpose: The aims of our study were to assess effects of the extent of capsular release and to define the benefit of additional release of the inferior glenohumeral ligament (IGHL) from inferior to posterior in frozen shoulder.

Methods: Seventy-four consecutive patients with refractory frozen shoulder underwent arthroscopic capsular release and were divided into 2 groups randomly. The release of anterior capsular structures, including the anterior band of the IGHL, was performed in group 1. In group 2 the release extended inferiorly and posteriorly. Constant functional scores were used to assess the outcome. The range of motion (ROM) in various directions was also recorded preoperatively and postoperatively.

Results: Follow-up was obtained in 41 patients in group 1 and 29 patients in group 2, and it averaged 28 months. At the last follow-up, there was a significant improvement in Constant score (P < .01) postoperatively in all patients. There was a significant and rapid reduction in the visual analog scale score in both groups postoperatively. No statistical difference in the visual analog scale score was found between the 2 groups at the corresponding time points. Overall, patients had restored shoulder ROM at the last follow-up without difference between group 1 and group 2. Abduction, flexion, external rotation at 90 degrees of abduction, internal rotation at 0 degrees of abduction, and internal rotation at 90 degrees of abduction recovered more rapidly in group 2 within 3 months after surgery; however, there was no significant difference in ROM after 6 months.

Conclusions: In this broad group of patients with recalcitrant adhesive capsulitis, the addition of the posterior capsular release did not improve patient function or ROM over anterior capsular release alone at 6 months. The extended release of the inferior and posterior IGHL would improve ROM more rapidly within the first 3 months postoperatively.

Level of evidence: Level I, therapeutic randomized controlled trial.