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Shoulder arthroscopy: adequate use

Report of the Spanish Network of Agencies for Assessing National Health System Technologies and Performance.

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Report available in Spanish.

Objetives

To assess the efficacy of shoulder arthroscopy for different pathologies and the safety of this procedure for the treatment of shoulder disorders.

Methodology

Study design: Systematic review of the scientific literature.

Searches of the following databases Medline, Scopus, The Cochrane Library Plus, ISI Web of Knowledge, TRIP Database, National Health Service Evidence, National Health Service Centre for Reviews and Dissemination, Health Technology Assessment Database, National Health Service Economic Evaluation Database, Database of Abstracts and Reviews of Effects were performed through the keywords of interest and the reference review of the most important articles. Studies with the highest scientific evidence have been selected since 2004.

Results

After the screening of 146 references, 1 clinical practice guidelines, 2 metaanalysis, 7 systematic reviews and meta-analysis, 32 systematic reviews and 1 randomized clinical trial were selected. The arthroscopic procedures for the surgical treatment of anterior, posterior and multidirectional glenohumeral instability, rotator cuff lesions, arthroscopic acromioplasty, arthroscopic surgery of SLAP (Superior Labrum from Anterior to Posterior) lesions, glenohumeral arthritis and adhesive capsulitis were effective in terms of functional scores and patient satisfaction. However, the results were not conclusive regarding the decrease in the rates of recurrence. To assess intervention safety the factors related with the development of glenohumeral chondrolysis, the most important adverse effect of arthroscopy, were assessed. The development of this pathology has no association with any particular diagnostic; whereas, the main risk factors were the mechanical, thermic and chemical procedures used during the intervention.

Conclusion

Shoulder arthroscopy could be an effective procedure for the treatment of the glenohumeral joint disorders. The results showed an improvement in functional scores and in the patient satisfaction rates in all pathologies analyzed. However, the results were not conclusive regarding the recurrence rate. The most frequent adverse effect of arthroscopy was the glenohumeral chondrolysis independently of the disorder treated. However, the development has been associated with the surgical procedure (mechanical, thermic and chemical variables).

Update:  16.05.2018