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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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