Is it safe for the cuff to perform a full circumferential arthroscopic capsular release for frozen shoulder? A...

Frozen shoulder causes prolonged pain and restricted range of motion (ROM), with many patients requiring surgery when conservative treatment fails. Arthroscopic capsular release (ACR) is a common intervention, but the optimal extent of release-particularly the safety of superior capsule release and risk of iatrogenic rotator cuff tears-remains controversial. The purpose of this systematic review is to evaluate the clinical effects of releasing the superior capsule of the shoulder as part of a full circumferential ACR, specifically evaluating the rate of postoperative rotator cuff tears.

A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, EMBASE, and Web of Science were searched. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized controlled trials (RoB 2.0) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. Included studies reported on frozen shoulder patients treated with circumferential ACR, with or without superior capsule release. Postoperative outcomes-ROM, functional scores, and complications like cuff tears-were extracted. A minimum follow-up of 1 year was required. Procedures including superior capsule release were classified as full circumferential ACR only when they included a superior capsule release; otherwise, they were considered limited ACR.

Forty-five studies with 1,921 patients (mean age 51.8 years, 59.1% female) met the inclusion criteria. Only 2 randomized controlled trials and 8 prospective studies were included, along with 35 retrospective studies, which generally exhibited a low to moderate risk of bias. Twenty-one studies (46.7%) used full circumferential and 24 (53.3%) used limited ACR. ROM and functional scores improved across all groups, with comparable outcomes between techniques. Only 3 postoperative cuff tears (0.16%) were reported-all in the full circumferential ACR group. However, postoperative imaging was reported in only 2 studies.

Full circumferential ACR, including superior capsule release, does not present a higher risk of rotator cuff tears, though the low incidence and limited imaging data suggest underreporting.