Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy

Ketola, Saara; Lehtinen, Janne; Arnala, I

doi:10.1302/0301-620x.99b6.bjj-2016-0569.r1

Cited by 74 publications

(41 citation statements)

References 28 publications

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“…In the short-term (up to 2 years), ASD did not alleviate shoulder symptoms any more than placebo surgery. 12 21 The existing long-term evidence of the effects of ASD, consisting of 5-10 years follow-up studies comparing ASD to exercise therapy, [7][8][9][10] is conflicting. In three of these unblinded trials, there was no clinically meaningful benefit, 7 8 10 while one trial suggested a benefit of ASD.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…The existing long-term evidence consists of 5-10 years follow-up studies comparing ASD to exercise therapy. [7][8][9][10] In three of these unblinded trials, there was no clinically meaningful benefit, 7 8 10 while one trial suggested a benefit of ASD. 9 Updates to the BMJ RapidRec guideline and the Cochrane review are pending low risk of bias evidence on the long-term outcomes on subacromial decompression surgery.…”

Section: Introductionmentioning

confidence: 99%

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Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

et al. 2020

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ObjectivesTo assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison).MethodsWe conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35–65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry.ResultsIn the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −2.0 (95% CI −8.5 to 4.6; p=0.56) at rest and −8.0 (−17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (−5.6 to 7.6; p=0.77) at rest and −3.9 (−12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events.ConclusionsASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.

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Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

et al. 2020

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“…In the last years, authors challenged the need for surgery in SAIS. A more comprehensive understanding of the pathogenesis lead to the publication of several papers which questioned the benefit of decompression surgery and the rationale of the “impingement” mechanism stating that placebo effect, prolonged rest, and intense physiotherapy after surgery have to be considered the true treatments 22–27…”

Section: Introductionmentioning

confidence: 99%

“…A qualitative analysis was hence performed. The minimum follow-up was 6 months27 and the longest was 13 years 22. Studies with large group of patients enrolled and long-term follow-up were preferred.…”

Section: Introductionmentioning

confidence: 99%

Subacromial impingement syndrome: management challenges

Consigliere

Haddo

Levy

et al. 2018

ORR

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The painful shoulder is the most common condition seen in specialist shoulder clinics. It is often associated with lack of range of motion and reduced shoulder function. Lack of sleep and difficulties in performing basic daily life activities are common findings. Subacromial Impingement Syndrome (SAIS) has been considered as the most common cause of shoulder pain since it was described in 1852. Charles Neer, in 1972, described the presence of a “proliferative spur and ridge” on the undersurface of the acromion, which needs to be removed to improve the symptoms (acromioplasty). Neer’s “impingement” hegemony was undisputed for at least 30 years. A more extensive knowledge of the pathogenesis of SAIS, however, has led authors to challenge the role of “impingement” in the shoulder pain and the role of surgical intervention. The aim of this review was to understand if there is still a role for surgical decompression in patients with SAIS. A literature review was performed in PubMed, PEDro, Embase, and the Cochrane Central Register of Controlled Trials using impingement, subacromial space, rotator cuff tears, tendinopathy, and tendinitis as key words. Randomized clinical trials (RCTs) with long-term follow-up comparing surgical intervention and conservative treatments in SAIS were preferred; however, prospective articles studying the outcome of surgical decompression and physiotherapy were also included. The majority of the studies showed no difference in the outcome between patients randomized to surgical decompression or conservative management. However, some studies reported better results after surgery, especially in the long term. Interpretation of the results is very difficult as most of the studies are of poor quality and have short follow-up. In our opinion, the type of subacromial lesion needs to be considered; this may offer an explanation to the difference in severity of symptoms and to the varying degrees of response to certain treatments, including surgery. Further studies are mandatory to better understand the role of surgery in SAIS.

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“…The scientific basis for the fundamental components of the impingement syndrome has, however, been questioned 220 . Increasing highlevel evidence, including placebo surgery trials, has also failed to show any clinically significant effect of the classical anterior acromioplasty above the effect seen with structured physiotherapy, both as treatment for subacromial pain 15,147,219 and as an adjunct to cuff repair 36 . In recent years the lateral extension of the acromion has come into focus instead 216 .…”

Section: Prevalence and Predisposing Factors For Rotator Cuff Tearmentioning

confidence: 99%

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Ranebo

2020

Linköping University Medical Dissertations

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Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy

Cited by 74 publications

References 28 publications

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

Subacromial impingement syndrome: management challenges

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

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