Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Forsythe, Brian; Lavoie-Gagne, Ophelie; Patel, Bhavik H.; Ritz, Ethan M.; Chahla, Jorge; Okoroha, Kelechi R.; Allen, Answorth A.; Nwachukwu, Benedict U.

doi:10.1016/j.arthro.2020.09.041

Cited by 19 publications

(19 citation statements)

References 89 publications

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“…Many studies have shown excellent short-, mid-and long-term results both in terms of lasting pain relief and ROM gains with ACR [98][99][100][101]. Comparing diabetics with non-diabetics, a recent systemic review concluded that clinical outcomes after ACR were inferior (more residual pain, reduced motion) in a diabetic patient compared to non-diabetic, and that must be explained to the patient during pre-ACR counselling [102].…”

Section: Operative Management Of Frozen Shouldermentioning

confidence: 99%

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

Pandey

Madi

2021

JOIO

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Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of ‘traditional clinicopathological staging’ of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12–18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6–9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.

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Section: Operative Management Of Frozen Shouldermentioning

confidence: 99%

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

Pandey

Madi

2021

JOIO

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“…In this issue's NMA on the management of adhesive capsulitis by Forsythe et al, 4 a variety of treatments are included. The networks for range of motion and pain are well connected in many areas, and physical therapy and injection are the 2 most represented treatments.…”

Section: Nma On the Management Of Adhesive Capsulitismentioning

confidence: 99%

“…3 An excellent example can be found in the current issue, where Forsythe, Lavoie-Gagne, Patel, Lu, Ritz, Chahla, Okoroha, Allen, and Nwachukwu synthesize Level I evidence regarding the "Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Metaanalysis of Randomized Controlled Trials." 4 To Understand NMA, Focus on the Geometry…”

mentioning

confidence: 99%

Understanding Network Meta-analysis (NMA) Conclusions Requires Scrutiny of Methods and Results: Introduction to NMA and the Geometry of Evidence

Cote¹,

Lubowitz

Brand

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Synthesis of medical literature to determine the best treatment for a given problem is challenging, particularly when multiple options exist. Network meta-analysis (NMA) allows the comparison of different treatment approaches in a single, systematic review including treatments that have never been compared head-to-head. A key to understanding NMA is to focus on the network geometry showing the number of included studies and their relationships: different treatment options are illustrated as nodes. Lines between nodes represent direct comparisons. For nodes not directly compared, indirect effects may be determined by use of the property of transitivity. Limitations of NMA include heterogeneity, where variability among included studies biases pairwise comparisons, and consistency, if direct and indirect comparisons between treatments do not agree. In the end, NMA allows numeric ranking of the estimated effects of each treatment from most to least effective. A disadvantage of NMA ranking methods is that readers may focus overly on what treatment ranks best and focus insufficiently on the methods and results that determine the rankings. The reliability of the rankings requires consideration of the geometry and strength of the network, including evaluation of heterogeneity, consistency, and transitivity. The conclusion of an NMA requires scrutiny of the methods and results.

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“…2 Its first line of treatment is conservative and not surgical as shown in a recent network meta-analysis. 3 Surgery should be reserved for those not responding to the conservative approach after a time period of 3 to 6 months' minimum. 4 That corticosteroid injections and physiotherapy are important parts of the conservative approach appears as an accepted treatment algorithm.…”

Section: See Related Article On Page 2031mentioning

confidence: 99%