Abstract
Purpose
The effect of arthroscopic subacromial decompression for impingement syndrome is still
under debate. The purpose of this study was to evaluate short-term and long-term effects
of arthroscopic decompression in patients with subacromial impingement.
Methods
A systematic literature search was performed in Pubmed, Embase, Scopus, Cochrane Library,
and ClinicalTrials.gov through March 2021 to identify randomized controlled trials
(RCTs) that evaluated the clinical effects of arthroscopic decompression versus placebo
surgery or exercise therapy for patients with subacromial impingement. Outcomes were
analyzed on an intention-to-treat basis with random-effects models.
Results
Nine RCTs were included in the meta-analysis. The pooled analysis showed that arthroscopic
decompression was associated with significantly better function improvement at 24-36
months and ≥ 60 months (24-36 months: SMD: 0.29, 95% CI: 0.10 to 0.48, P = 0.002;
≥ 60 months: SMD, 0.65, 95% CI, 0.20 to 1.09, P=0.004) compared with control group.
Moreover, the effect size of function improvement ≥ 60 months exceeded the minimum
clinically important difference (MCID). Additionally, sensitivity analysis indicated
that compared with either exercise therapy or placebo surgery, arthroscopic decompression
was associated with significantly better function improvement ≥ 60 months follow-up.
However, there was no significant difference regarding pain relief at 6 months, 12
months, 24-36 months, ≥ 60 months, and function improvement at 6 months, 12 months
for arthroscopic decompression compared with control group.
Conclusion
After ≥ 60 months of follow-up, arthroscopic decompression in patients with subacromial
impingement appears to render better function results than exercise therapy and placebo
surgery.
Level of Evidence
I, systematic review and meta-analysis of level I studies.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of shoulder pain in the community: the influence of case definition.Ann Rheum Dis. 1997; 56: 308-312
- Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation.Ann Rheum Dis. 1998; 57: 649-655
- Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity.Rheumatology (Oxford). 1999; 38: 656-662
- Self-assessment of general health status in patients with five common shoulder conditions.J Shoulder Elbow Surg. 1998; 7: 228-237
- Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy.Arthroscopy. 2021; 37: 2745-2753
- Platelet-Rich Plasma Has Better Results for Retear Rate, Pain, and Outcome Than Platelet-Rich Fibrin After Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials.Arthroscopy. 2022; 38: 539-550
- The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff: a systematic review and meta-analysis.Arthroscopy. 2012; 28: 720-727
Neer CS, 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Joint Surg Am. 2005;87:1399.
- Shoulder disorders in general practice: incidence, patient characteristics, and management.Ann Rheum Dis. 1995; 54: 959-964
- Subacromial decompression in patients with shoulder impingement with an intact rotator cuff: An expert consensus statement using the modified Delphi Technique comparing North American to European shoulder surgeons.Arthroscopy. 2021;
- National Trends Show Declining Use of Arthroscopic Subacromial Decompression Without Rotator Cuff Repair.Arthroscopy. 2021; 37: 3397-3404
- Indications for Arthroscopic Subacromial Decompression. A Level V Evidence Clinical Guideline.Arthroscopy. 2020; 36: 913-922
- Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression.Arthroscopy. 2016; 32: 409-415
- Arthroscopic subacromial decompression: analysis of one- to three-year results.Arthroscopy. 1987; 3: 173-181
- Long-term patient satisfaction and functional outcome 8-11 years after subacromial decompression.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 394-403
- Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients.Acta Orthop. 2011; 82: 711-713
- Arthroscopic surgery versus supervised exercises in patients with rotator cuff disease (stage II impingement syndrome): a prospective, randomized, controlled study in 125 patients with a 2 1/2-year follow-up.J Shoulder Elbow Surg. 1999; 8: 102-111
- Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review.Arch Phys Med Rehabil. 2011; 92: 1900-1913
- Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up.Ann Rheum Dis. 2005; 64: 760-764
Higgins J. GSe. Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011.
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- A random-effects regression model for meta-analysis.Stat Med. 1995; 14: 395-411
- Minimal important difference and patient acceptable symptom state for pain, Constant-Murley score and Simple Shoulder Test in patients with subacromial pain syndrome.BMC Med Res Methodol. 2021; 21: 45
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.J Clin Epidemiol. 2001; 54: 1046-1055
- Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: a prospective randomised study.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2181-2191
- Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial.J Bone Joint Surg Br. 2009; 91: 1326-1334
- No evidence of long-term benefits of arthroscopicacromioplasty in the treatment of shoulder impingement syndrome: Five-year results of a randomised controlled trial.Bone Joint Res. 2013; 2: 132-139
- Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial.BMJ. 2018; 362k2860
- Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.Lancet. 2018; 391: 329-338
- Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome).BMJ. 1993; 307: 899-903
- Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up.Am J Sports Med. 2018; 46: 1397-1407
- Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study.J Bone Joint Surg Br. 2009; 91: 504-510
- Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years.Bone Joint J. 2017; 99-b: 799-805
- Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial.Br J Sports Med. 2021; 55: 99-107
- [Mid-term clinical results after surgical versus conservative treatment of subacromial impingement syndrome].Unfallchirurg. 1997; 100: 623-629
- Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis.Arthroscopy. 2007; 23: 1042-1051
- Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome.Clin Rehabil. 2011; 25: 69-78
- Conservative or surgical treatment for subacromial impingement syndrome? A systematic review.J Shoulder Elbow Surg. 2009; 18: 652-660
- Significant benefit for older patients after arthroscopic subacromial decompression: a long-term follow-up study.Int Orthop. 2013; 37: 457-462
- Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair.Am J Sports Med. 2020; 48: 2650-2659
- Minimal Clinically Important Differences and Correlating Factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score After Arthroscopic Stabilization Surgery for Anterior Shoulder Instability.Arthroscopy. 2019; 35: 54-59
- Outcome measures and implications for sample-size calculations.J Bone Joint Surg Am. 2009; 91: 35-40
- Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis.Br J Sports Med. 2020; 54: 665-673
- Subacromial decompression surgery for rotator cuff disease.Cochrane Database Syst Rev. 2019; 1: Cd005619
Article Info
Publication History
Accepted:
June 8,
2022
Received in revised form:
March 25,
2022
Received:
July 16,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
Funding
None.
Conflicts of interest
The authors have no conflicts of interest to disclose in relation to this article.
Identification
Copyright
© 2022 Published by Elsevier on behalf of the Arthroscopy Association of North America
