Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up

Farfaras, Stefanos; Sernert, Ninni; Christensen, Lars Rostgård; Hallström, Erling; Kartus, Jüri-Toomas

doi:10.1177/0363546518755759

Cited by 54 publications

(47 citation statements)

References 40 publications

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“…We found low certainty evidence of no benefit of surgery in the incidence of full-thickness supraspinatus tendon tears (diagnosed with MRI 36 ) at 5 years (1 trial, 90 participants: RR 1.00, 95% CI 0.40 to 2.52). 31 (online supplementary appendix table 6).…”

Section: Secondary Comparisonsmentioning

confidence: 99%

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Lähdeoja¹,

Karjalainen²,

Jokihaara³

et al. 2019

Br J Sports Med

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Section: Secondary Comparisonsmentioning

confidence: 99%

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Lähdeoja¹,

Karjalainen²,

Jokihaara³

et al. 2019

Br J Sports Med

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“…The existing long-term evidence consists of 5-10 years follow-up studies comparing ASD to exercise therapy. [7][8][9][10] In three of these unblinded trials, there was no clinically meaningful benefit, 7 8 10 while one trial suggested a benefit of ASD. 9 Updates to the BMJ RapidRec guideline and the Cochrane review are pending low risk of bias evidence on the long-term outcomes on subacromial decompression surgery.…”

Section: Introductionmentioning

confidence: 99%

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

et al. 2020

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ObjectivesTo assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison).MethodsWe conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35–65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry.ResultsIn the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −2.0 (95% CI −8.5 to 4.6; p=0.56) at rest and −8.0 (−17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (−5.6 to 7.6; p=0.77) at rest and −3.9 (−12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events.ConclusionsASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.

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“…Bemerkenswert ist, dass die Symptomminderung nach der chirurgischen im Vergleich zu Kontroll-Patienten auf einer Warteliste auch nicht den Schwellenwert einer klinisch bedeutsamen Veränderung erreicht [4]. Kürzlich wurde auch beschrieben, dass die subacromiale Dekompression im Verlauf von über 10 Jahren zu weniger Rupturen der Rotatorenmanschette führt als die alleinige Bewegungstherapie [5]. Dieses Argument für die operative Therapie bedarf jedoch der Bestätigung durch longitudinale Kohortenstudien,…”

Section: Kommentarunclassified

Behandlung des Impingement-Syndroms der Schulter: diagnostische Arthroskopie oder arthroskopische subacromiale Dekompression oder Bewegungstherapie?

2018

Phys Med Rehab Kuror

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Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up

Abstract: After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA.

Cited by 54 publications

References 40 publications

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

Behandlung des Impingement-Syndroms der Schulter: diagnostische Arthroskopie oder arthroskopische subacromiale Dekompression oder Bewegungstherapie?

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