title: Failed subacromial decompression. Risk factors.
abstract: BACKGROUND
  Arthroscopic subacromial decompression (acromioplasty) is widely held to be effective, although pain may persist after the procedure. The objective of this study was to evaluate the proportion of patients with residual pain (i.e., the failure rate) after isolated subacromial decompression and to look for predictors of failure.
  
  
  METHODS
  We conducted a retrospective multicentre study of 108 patients managed with isolated arthroscopic subacromial decompression between 2007 and 2011, for any reason. We excluded patients in whom surgical procedures on the rotator cuff tendons were performed concomitantly. Data were collected from the medical records, a telephone questionnaire, and radiographs obtained before surgery and at last follow-up. Failure was defined as persistent pain (visual analogue scale score>3) more than 6 months after surgery and at last follow-up.
  
  
  RESULTS
  The failure rate was 29% (31/108). Two factors significantly predicted failure, namely, receiving workers' compensation benefits for the shoulder condition and co-planing. Heterogeneous calcific tendinopathy and deep partial-thickness rotator cuff tears were also associated with poorer outcomes, but the effect was not statistically significant.
  
  
  CONCLUSIONS
  Co-planing may predict failure of subacromial decompression, although whether this effect is due to an insufficient degree of co-planing or to the technique itself is unclear. Nevertheless, in patients with symptoms from the acromio-clavicular joint, acromio-clavicular resection is probably the best option. Receiving workers' compensation benefits was also associated with treatment failure, as a result of well-known parameters related to the social welfare system.
  
  
  CONCLUSIONS
  Isolated arthroscopic subacromial decompression is effective in 70% of cases. We recommend the utmost caution if co-planing is considered and/or the patient receives workers' compensation benefits for the shoulder condition, as these two factors are associated with a significant increase in the failure rate.
  
  
  METHODS
  IV (retrospective study).
authors.affiliation: Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France. Electronic address: antoine.bouch@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Bouchard
authors.affiliation: Clinique du Parc, 69000 Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Garret
authors.affiliation: Hôpital Trousseau, CHU de Tours, 37000 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Favard
authors.affiliation: 13, place Philippe Lebon, 59000 Lille, France.
authors.forename: H
authors.initials: H
authors.lastname: Charles
authors.affiliation: Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France.
authors.forename: D
authors.initials: D
authors.lastname: Ollat
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects*; D002968:Clavicle / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D017006:Rotator Cuff / Q000601:surgery; D019534:Shoulder Impingement Syndrome / Q000601:surgery*; D017211:Treatment Failure
keywords: Arthroscopic subacromial decompression; Subacromial impingement syndrome; Treatment failure