Patients with subacromial impingement experience better long-term functional outcomes with arthroscopic subacromial decompression according to a new Chinese study.
Arthroscopic Shoulder Decompression Better Than Exercise?
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The study, “Arthroscopic subacromial decompression improves long-term functional outcome in patients with subacromial impingement: A systematic review and meta-analysis of randomized controlled trials,” published on July 9, 2022 in the journal Arthroscopy.
“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,” the researchers wrote.
The research group, based out of Peking Third University Hospital in Beijing, performed a systematic literature search of PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov for any studies that evaluate the clinical effects of arthroscopic decompression versus placebo surgery or exercise therapy for patients with subacromial impingement.
Ultimately, after searching the databases through March 2021, the team found 9 randomized controlled trials to include in their meta-analysis.
After reviewing the 9 studies, the research team found that arthroscopic decompression was associated with better function improvement at 24-36 months and 60 months or longer (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) than the control groups.
Sensitivity analysis confirmed that arthroscopic decompression was superior to either exercise therapy or placebo surgery after 60 months. However, the researchers did not find significant differences in pain relief at 6, 12, 24-36, greater than or equal to 60 months, and function improvement at 6 and 12 months for arthroscopic decompression compared with the control group.
“After 60 months or longer of follow-up, arthroscopic decompression in patients with subacromial impingement appears to render better function results than exercise therapy and placebo surgery,” the researchers wrote.
The study authors included Wenli Dai, M.D., Wengiang Yan, M.D., Xi Leng, M.D., Jian Wang, M.D., Xiaoqing Hu, M.D., and Yingfang Ao, Ph.D., all from Peking University Third Hospital, Beijing, People’s Republic of China.
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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.
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