Does arthroscopic capsular shift surgery for joint instability improve pain?

A recent study by Anju Jaggi and team found that arthroscopic capsular shift surgery individuals with atraumatic shoulder joint instability confers only minimal clinically important benefits in the medium term when compared to diagnostic arthroscopy alone. The findings of the study published in British Journal of Sports Medicine.

The randomized, placebo-controlled trial involved patients aged 18 and above who reported insecurity or apprehension in their shoulder joint, along with evidence of capsulolabral damage revealed through arthroscopic examination. However, patients with shoulder apprehension symptoms triggered by a high-velocity shoulder injury, those with bony or neural damage, a rotator cuff or labral tear, or a history of previous surgery on the symptomatic shoulder were excluded from the study.

Sixty-eight participants were randomized into two groups, one receiving diagnostic arthroscopy alone and the other undergoing arthroscopic capsular shift following diagnostic arthroscopy. All participants received the same postoperative clinical care.

The primary outcome measured in the study was pain and functional impairment, quantified using the Western Ontario Shoulder Instability Index. The researchers established a prespecified minimum clinically important effect of a 10.4-point reduction in pain and disability.

Surprisingly, the results showed that mean reductions in pain and functional impairment for both groups were similar. In comparison to diagnostic arthroscopy alone, the arthroscopic capsular shift group displayed an increase in pain and functional impairment by 5 points (95% CI -6 to 16 points) at 6 months, 1 point (95% CI -11 to 13 points) at 12 months, and 2 points (95% CI -12 to 17 points) at 24 months.

These findings suggest that arthroscopic capsular shift surgery may not significantly alleviate pain or improve functional impairment for patients with atraumatic shoulder joint instability. This study highlights the need for further investigation into alternative interventions that may provide more substantial and lasting benefits to patients. It also underscores the importance of evidence-based medicine in guiding treatment decisions for musculoskeletal conditions.

Source:

Jaggi, A., Herbert, R. D., Alexander, S., Majed, A., Butt, D., Higgs, D., Rudge, W., & Ginn, K. A. (2023). Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomised, placebo-controlled trial. In British Journal of Sports Medicine (p. bjsports-2022-106596). BMJ. https://doi.org/10.1136/bjsports-2022-106596