Long-term Outcomes of Arthroscopic Acromioplasty for Chronic Shoulder Impingement Syndrome: A Prospective Cohort Study With a Minimum of 12 Years' Follow-up

Purpose: The purpose of this study was to evaluate long-term outcomes of arthroscopic acromioplasty for shoulder impingement syndrome. Methods: This was a prospective cohort study of 31 shoulders (24 men) that underwent arthroscopic acromioplasty for shoulder impingement syndrome during 1992 and 1993. The mean age at surgery was 49 years (range, 33 to 68 years). A group of 29 shoulders (22 men) operated on consecutively with open acromioplasty from 1985 through 1991 served as controls. The patients were evaluated with the University of California, Los Angeles (UCLA) score (range, 0 to 35 points) at baseline and at 2 follow-up times performed at a mean of 1 and 13 years after surgery, respectively. At the second follow-up, the Disabilities of the Arm, Shoulder and Hand score, the Short Form–36 bodily pain score, and the EQ-5D health utility index also were obtained. Results: After arthroscopic acromioplasty, the mean improvement in UCLA score from baseline to long-term follow-up was 13 points (95% confidence interval, 11 to 15 points), and the scores indicated an excellent or good result in 77% of shoulders. The mean UCLA score was 32 points (SD, 5 points) for the patients treated with arthroscopic acromioplasty and 28 points (SD, 8 points) for those treated with open acromioplasty; the mean difference was 4.3 points (95% confidence interval, 0.4 to 8.2 points; P = .03). In a mixed-model analysis adjusting for age, sex, duration of symptoms, preoperative UCLA score, dominance of operated side, rotator cuff status at surgery, and time since surgery, the rate of change from baseline in UCLA score over time was significantly better after arthroscopic surgery than after open surgery. Conclusions: Good results of arthroscopic acromioplasty were maintained at 12 to 14 years after surgery with excellent or good results shown in 77% of shoulders, and the long-term outcomes were superior to those after open acromioplasty. Level of Evidence: Level III, therapeutic case-control study.

Key Words: Acromioplasty, Shoulder impingement, Arthroscopic subacromial decompression, Long-term outcomes, UCLA score