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Arthroscopic subacromial decompression improves long-term functional outcome in patients with subacromial impingement: A systematic review and meta-analysis of randomized controlled trials

  • Author Footnotes
    # These authors have contributed equally to this work.
    Wenli Dai
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Wenqiang Yan
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China
    Search for articles by this author
  • Xi Leng
    Affiliations
    Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, Guangdong 510405, People's Republic of China
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  • Jian Wang
    Affiliations
    Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Road, Baiyun District, Guangzhou, Guangdong 510515, People's Republic of China
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  • Xiaoqing Hu
    Correspondence
    Corresponding to: Dr. Xiaoqing Hu, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China.
    Affiliations
    Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China
    Search for articles by this author
  • Yingfang Ao
    Correspondence
    Corresponding to: Prof. Yingfang Ao, Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China.
    Affiliations
    Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China
    Search for articles by this author
  • Author Footnotes
    # These authors have contributed equally to this work.

      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.
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