Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression

Published:October 24, 2015DOI:


      To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years.


      We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery.


      Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate.


      Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Schibany N.
        • Zehetgruber H.
        • Kainberger F.
        • et al.
        Rotator cuff tears in asymptomatic individuals: A clinical and ultrasonographic screening study.
        Eur J Radiol. 2004; 51: 263-268
        • Tempelhof S.
        • Rupp S.
        • Seil R.
        Age-related prevalence of rotator cuff tears in asymptomatic shoulders.
        J Shoulder Elbow Surg. 1999; 8: 296-299
        • Yamamoto A.
        • Takagishi K.
        • Osawa T.
        • et al.
        Prevalence and risk factors of a rotator cuff tear in the general population.
        J Shoulder Elbow Surg. 2010; 19: 116-120
        • Neer II, C.S.
        Impingement lesions.
        Clin Orthop Relat Res. 1983; 173: 70-77
        • Neer II, C.S.
        Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972.
        J Bone Joint Surg Am. 2005; 87: 1399
        • Ellman H.
        • Gartsman G.M.
        Arthroscopic shoulder surgery and related procedures.
        Lea & Febiger, Malvern, PA1993
        • Gartsman G.M.
        Arthroscopic acromioplasty for lesions of the rotator cuff.
        J Bone Joint Surg Am. 1990; 72: 169-180
        • Checroun A.J.
        • Dennis M.G.
        • Zuckerman J.D.
        Open versus arthroscopic decompression for subacromial impingement. A comprehensive review of the literature from the last 25 years.
        Bull Hosp Jt Dis. 1998; 57: 145-151
        • Gebremariam L.
        • Hay E.M.
        • Koes B.W.
        • Huisstede B.M.
        Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: A systematic review.
        Arch Phys Med Rehabil. 2011; 92: 1900-1913
        • Spangehl M.J.
        • Hawkins R.H.
        • McCormack R.G.
        • Loomer R.L.
        Arthroscopic versus open acromioplasty: A prospective, randomized, blinded study.
        J Shoulder Elbow Surg. 2002; 11: 101-107
        • Dorrestijn O.
        • Stevens M.
        • Winters J.C.
        • van der Meer K.
        • Diercks R.L.
        Conservative or surgical treatment for subacromial impingement syndrome? A systematic review.
        J Shoulder Elbow Surg. 2009; 18: 652-660
        • Kempf J.
        • Gleyze P.
        • Bonnomet F.
        • et al.
        A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.
        Arthroscopy. 1999; 15: 56-66
        • Biberthaler P.
        • Beirer M.
        • Kirchhoff S.
        • Braunstein V.
        • Wiedemann E.
        • Kirchhoff C.
        Significant benefit for older patients after arthroscopic subacromial decompression: A long-term follow-up study.
        Int Orthop. 2013; 37: 457-462
        • Eid A.S.
        • Dwyer A.J.
        • Chambler A.F.
        Mid-term results of arthroscopic subacromial decompression in patients with or without partial thickness rotator cuff tears.
        Int J Shoulder Surg. 2012; 6: 86-89
        • Massoud S.N.
        • Levy O.
        • Copeland S.A.
        Subacromial decompression. Treatment for small- and medium-sized tears of the rotator cuff.
        J Bone Joint Surg Br. 2002; 84: 955-960
        • Norlin R.
        • Adolfsson L.
        Small full-thickness tears do well ten to thirteen years after arthroscopic subacromial decompression.
        J Shoulder Elbow Surg. 2008; 17: 12S-16S
        • Balke M.
        • Bielefeld R.
        • Schmidt C.
        • Dedy N.
        • Liem D.
        Calcifying tendinitis of the shoulder: Midterm results after arthroscopic treatment.
        Am J Sports Med. 2012; 40: 657-661
        • Jerosch J.
        • Strauss J.M.
        • Schmiel S.
        Arthroscopic treatment of calcific tendinitis of the shoulder.
        J Shoulder Elbow Surg. 1998; 7: 30-37
        • Rizzello G.
        • Franceschi F.
        • Longo U.G.
        • et al.
        Arthroscopic management of calcific tendinopathy of the shoulder—do we need to remove all the deposit?.
        Bull NYU Hosp Jt Dis. 2009; 67: 330-333
        • Rupp S.
        • Seil R.
        • Kohn D.
        Tendinosis calcarea of the rotator cuff.
        Orthopade. 2000; 29: 852-867
        • Hawkins R.J.
        • Kennedy J.C.
        Impingement syndrome in athletes.
        Am J Sports Med. 1980; 8: 151-158
        • Patte D.
        Classification of rotator cuff lesions.
        Clin Orthop Relat Res. 1990; 254: 81-86
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop Relat Res. 1987; 214: 160-164
        • Constant C.R.
        • Gerber C.
        • Emery R.J.
        • Sojbjerg J.O.
        • Gohlke F.
        • Boileau P.
        A review of the Constant score: Modifications and guidelines for its use.
        J Shoulder Elbow Surg. 2008; 17: 355-361
        • Katolik L.I.
        • Romeo A.A.
        • Cole B.J.
        • Verma N.N.
        • Hayden J.K.
        • Bach B.R.
        Normalization of the Constant score.
        J Shoulder Elbow Surg. 2005; 14: 279-285
        • Tavakkolizadeh A.
        • Ghassemi A.
        • Colegate-Stone T.
        • Latif A.
        • Sinha J.
        Gender-specific Constant score correction for age.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 529-533
        • Walther M.
        • Werner A.
        • Stahlschmidt T.
        • Woelfel R.
        • Gohlke F.
        The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: Results of a prospective, randomized study.
        J Shoulder Elbow Surg. 2004; 13: 417-423
        • Björnsson H.
        • Norlin R.
        • Knutsson A.
        • Adolfsson L.
        Fewer rotator cuff tears fifteen years after arthroscopic subacromial decompression.
        J Shoulder Elbow Surg. 2010; 19: 111-115
        • Odenbring S.
        • Wagner P.
        • Atroshi I.
        Long-term outcomes of arthroscopic acromioplasty for chronic shoulder impingement syndrome: A prospective cohort study with a minimum of 12 years' follow-up.
        Arthroscopy. 2008; 24: 1092-1098
        • Magaji S.A.
        • Singh H.P.
        • Pandey R.K.
        Arthroscopic subacromial decompression is effective in selected patients with shoulder impingement syndrome.
        J Bone Joint Surg Br. 2012; 94: 1086-1089
        • Chin P.Y.
        • Sperling J.W.
        • Cofield R.H.
        • Stuart M.J.
        • Crownhart B.S.
        Anterior acromioplasty for the shoulder impingement syndrome: Long-term outcome.
        J Shoulder Elbow Surg. 2007; 16: 697-700
        • Neer II, C.S.
        • Craig E.V.
        • Fukuda H.
        Cuff-tear arthropathy.
        J Bone Joint Surg Am. 1983; 65: 1232-1244
        • Hsu H.C.
        • Luo Z.P.
        • Stone J.J.
        • Huang T.H.
        • An K.N.
        Correlation between rotator cuff tear and glenohumeral degeneration.
        Acta Orthop Scand. 2003; 74: 89-94
        • Ecklund K.J.
        • Lee T.Q.
        • Tibone J.
        • Gupta R.
        Rotator cuff tear arthropathy.
        J Am Acad Orthop Surg. 2007; 15: 340-349
        • Brunner U.
        • Rückl K.
        • Fruth M.
        Defektarthropathie – Langzeitergebnisse der inversen Schultertotalendoprothesenimplantation.
        Der Orthopäde. 2013; 42 ([in German]): 522-530
        • Elki S.
        • Rühmann O.
        • Benson S.
        • Berndt T.
        Die Glenoid-Rekonstruktionsschale bei Defektarthropathie.
        Obere Extremität. 2009; 4 ([in German]): 246-255
        • Marder R.A.
        • Heiden E.A.
        • Kim S.
        Calcific tendonitis of the shoulder: Is subacromial decompression with removal of the calcific deposit beneficial?.
        J Shoulder Elbow Surg. 2011; 20: 955-960
        • Porcellini G.
        • Paladini P.
        • Campi F.
        • Paganelli M.
        Arthroscopic treatment of calcifying tendinitis of the shoulder: Clinical and ultrasonographic follow-up findings at two to five years.
        J Shoulder Elbow Surg. 2004; 13: 503-508
        • Tillander B.M.
        • Norlin R.O.
        Change of calcifications after arthroscopic subacromial decompression.
        J Shoulder Elbow Surg. 1998; 7: 213-217