Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial.
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.
Ketola
S
S
Kanta-Häme Central Hospital, Hämeenlinna, Finland.
Lehtinen
J
J
Arnala
I
I
Nissinen
M
M
Westenius
H
H
Sintonen
H
H
Aronen
P
P
Konttinen
Y T
YT
Malmivaara
A
A
Rousi
T
T
D000174:Acromion / Q000601:surgery*; D000328:Adult; D001182:Arthroscopy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000191:economics; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D019534:Shoulder Impingement Syndrome / Q000191:economics / Q000534:rehabilitation / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult