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Arthroscopic acromioplasty may provide better long-term outcomes than open acromioplasty for chronic shoulder impingement syndrome

Friday, October 03 2008 | Comments

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What's This? New study findings indicate that arthroscopic acromioplasty may yield superior outcomes at 12 to 14 years following surgery than open acromioplasty among patients with chronic shoulder impingement syndrome.

To assess the long-term results of arthroscopic acromioplasty for shoulder impingement syndrome, researchers studied the outcomes of 31 shoulders in 27 subjects who underwent arthroscopic acromioplasty between February 1992 and November 1993. These patients were compared with 29 shoulders in 24 control subjects who had open acromioplasty from 1985 through 1991.

At the first follow-up, which was performed from June through December 1993, the participants underwent a physical examination and were evaluated with a University of California, Los Angeles (UCLA) score. The second and final follow-up took place from March 2005 to April 2006 and had an observation time of 12 to 14 years. The investigators added the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the Short Form (SF)-36 bodily pain score, and the EQ-5D health utility index to the second follow-up.

By the final follow-up, 4 patients (5 shoulders) had died and 1 patient could not be traced in the arthroscopic surgery group.

According to the outcomes, the arthroscopic acromioplasty patients had a significantly better mean UCLA score than the open surgery group (32.1 vs. 27.8). The average UCLA score difference between the 2 groups was 4.3 (95% CI, 0.4-8.2; P=.03). In addition, the authors found that UCLA scores classified as excellent or good result were recorded in 20 (77%) of the 26 shoulders that had undergone arthroscopic acromioplasty.

The mean SF-36 bodily pain score, mean DASH score, and mean EQ-5D index were better in the arthroscopic acromioplasty group than in the control group by 7 points, 5 points, and .07 points, respectively. However, these differences were not statistically significant. The median DASH score was 17 points in the arthroscopic acromioplasty cohort and 28 points in the open acromioplasty group, which was not statistically significant; however, the researchers noted that this difference "may be clinically important despite statistical nonsignificance."

"This prospective cohort study of arthroscopic acromioplasty for shoulder impingement syndrome showed that good short-term results are maintained after a minimum of 12 years and that arthroscopic acromioplasty appears to yield better long-term results than open acromioplasty," the authors concluded. (Odenring S, et al. Arthroscopy 2008:24:1092-1098.)

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