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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 10, 1326-1334.
doi: 10.1302/0301-620X.91B10.22094  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?

A TWO-YEAR RANDOMISED CONTROLLED TRIAL

S. Ketola, MD, Orthopaedic Surgeon1; J. Lehtinen, MD, PhD, Orthopaedic Surgeon2; I. Arnala, MD, PhD, Adjunct Professor, Orthopaedic Surgeon3; M. Nissinen, MD, PhD, Adjunct Professor, Rehabilitation Physician3; H. Westenius, MD, Orthopaedic Surgeon3; H. Sintonen, PhD, Professor of Health Economics4; P. Aronen, MSocSci, Researcher4; Y. T. Konttinen, MD, PhD, Professor of Medicine4; A. Malmivaara, MD, PhD, Adjunct Professor, Rehabilitation Physician5; and T. Rousi, MD, Rehabilitation Physician3

1 COXA Hospital for Joint Replacement, Biokatu 6b, PO Box 652, 33101 Tampere, Finland.
2 Tampere University Hospital, PO Box 2000 Teiskontie 35, 33521, Tampere, Finland
3 Kanta-Häme Central Hospital, Ahvenistontie 20, 13530 Hämeenlinna, Finland.
4 Department of Public Health, University of Helsinki, PO Box 41, 00014, Helsinki, Finland
5 Finnish Office for Health Care Technology Assessment, PO Box 220, Lintulahdenkuja 4, 00531 Helsinki, Finland.

Correspondence should be sent to Dr I. Arnala; e-mail: ilkka.arnala{at}khshp.fi

We report a randomised controlled trial to examine the effectiveness and cost-effectiveness of arthroscopic acromioplasty in the treatment of stage II shoulder impingement syndrome. A total of 140 patients were randomly divided into two treatment groups: supervised exercise programme (n = 70, exercise group) and arthroscopic acromioplasty followed by a similar exercise programme (n = 70, combined treatment group). The main outcome measure was self-reported pain on a visual analogue scale of 0 to 10 at 24 months, measured on the 134 patients (66 in the exercise group and 68 in the combined treatment group) for whom endpoint data were available.

An intention-to-treat analysis disclosed an improvement in both groups but without statistically significant difference in outcome between the groups (p = 0.65). The combined treatment was considerably more costly.

Arthroscopic acromioplasty provides no clinically important effects over a structured and supervised exercise programme alone in terms of subjective outcome or cost-effectiveness when measured at 24 months. Structured exercise treatment should be the basis for treatment of shoulder impingement syndrome, with operative treatment offered judiciously until its true merit is proven.




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Does arthroscopic acromioplasty provide additional value in the treatment of shoulder impingement?
Lydia Milnes, et al.
J Bone Joint Surg Br Online, 19 Nov 2009 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General