No evidence of long-term benefits of arthroscopicacromioplasty in the treatment of shoulder impingement syndrome: Five-year results of a randomised controlled trial

S Ketola, J Lehtinen, T Rousi, M Nissinen, H Huhtala, Y T Konttinen, I Arnala, S Ketola, J Lehtinen, T Rousi, M Nissinen, H Huhtala, Y T Konttinen, I Arnala

Abstract

Objectives: To report the five-year results of a randomised controlled trial examining the effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome.

Methods: A total of 140 patients were randomly divided into two groups: 1) supervised exercise programme (n = 70, exercise group); and 2) arthroscopic acromioplasty followed by a similar exercise programme (n = 70, combined treatment group).

Results: The main outcome measure was self-reported pain as measured on a visual analogue scale. At the five-year assessment a total of 109 patients were examined (52 in the exercise group and 57 in the combined treatment group). There was a significant decrease in mean self-reported pain on the VAS between baseline and the five-year follow-up in both the exercise group (from 6.5 (1 to 10) to 2.2 (0 to 8); p < 0.001) and the combined treatment group (from 6.4 (2 to 10) to 1.9 (0 to 8); p < 0.001). The same trend was seen in the secondary outcome measures (disability, working ability, pain at night, Shoulder Disability Questionnaire and reported painful days). An intention-to-treat analysis showed statistically significant improvements in both groups at five years compared with baseline. Further, improvement continued between the two- and five-year timepoints. No statistically significant differences were found in the patient-centred primary and secondary parameters between the two treatment groups.

Conclusions: Differences in the patient-centred primary and secondary parameters between the two treatment groups were not statistically significant, suggesting that acromioplasty is not cost-effective. Structured exercise treatment seems to be the treatment of choice for shoulder impingement syndrome.

Keywords: Acromioplasty; Arthroscopic; Operation; Physiotherapy; Shoulder impingement; Syndrome.

Conflict of interest statement

ICMJE Conflict of Interest:None declared

Figures

Fig. 1
Fig. 1
Graph showing the 15D Quality of Life index in the combined and exercise treatment groups and in comparison with age-adjusted standard population at five years.

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