For patients with shoulder impingement syndrome, arthroscopic subacromial decompression offers no real benefit compared to diagnostic arthroscopy or exercise therapy at 5 years post injury, a new study finds.
Subacromial Decompression Vs. Placebo Surgery: No Difference
1 min read Premium comments
Secondary#diagnosticarthroscopy#exercisetherapy#subacromialdecompression
In “Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomized placebo surgery controlled clinical trial,” published in the January 2021 issue of the British Journal of Sports Medicine, the researchers found no between-group differences for primary outcomes at 5 years.
The long-term efficacy of arthroscopic subacromial decompression (ASD) was compared with the efficacy of diagnostic arthroscopy and exercise therapy.
The multicenter randomized, controlled trial included 210 patients, aged 35 to 65 years. All the participants had symptoms consistent with shoulder impingement syndrome for more than 3 months. Eighty-three percent of them completed the 5-year follow-up. The trial was conducted between February 2005 and 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.
In the primary intention to treat analysis (ASD vs. diagnostic arthroscopy), there were no between-group differences that exceed the MID for primary outcomes at 5 years. The mean difference between the two groups 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.
No between-group differences were found to exceed the MID in the comparison between ASD and exercise therapy either. In the secondary comparison, the mean differences between the two groups 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.
The researchers wrote, “ASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with should impingement syndrome.”
Previous studies have found there was little benefit to ASD in the short term, but this is the first study to confirm that there are no long-term benefits either, they said.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.