Subacromial decompression does not affect rotator cuff repair outcome, study shows

Patient age, tear pattern and repair quality influenced results regardless of coracoacromial arch integrity or morphology.

Subacromial decompression does not significantly influence functional outcomes after the arthroscopic repair of full-thickness rotator cuff tears, according to results of a prospective study by Italian researchers.

"We did not observe better results when acromioplasty was performed or worse results when the coracoacromial arch was left intact, even in the presence of a type 3 acromion, independently from all other variables considered," the authors said in the study.

"On the basis of these results, we can hypothesize that improvement in function and relief of symptoms were related to a dynamic effect of the rotator cuff in positioning the humeral head into the glenoid, thus increasing the acromiohumeral distance and reducing the impingement phenomenon. When repair failed to restore function and strength ... shoulder pain and weakness persisted despite acromioplasty," they said.

Giuseppe Milano, MD, and colleagues at Catholic University in Rome compared clinical outcomes after arthroscopic rotator cuff repair between patients randomly assigned to undergo surgery either with or without subacromial decompression. They published their results in Arthroscopy.

The first group included data for 37 patients treated with subacromial decompression, which involved anterior-inferior acromioplasty, coracoacromial ligament release and subacromial bursectomy. The second group included data for 34 patients who received only subacromial bursectomy in addition to the arthroscopic repair.

The researchers saw no differences between groups for each independent variable analyzed, they said.

Constant-Murley scores averaged 103.6 points for patients treated with subacromial decompression and 96.1 for control patients. Scores for the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire averaged 18.2 points for the decompression group and 23.1 points for controls. Scores for the working capacity module of the DASH questionnaire (work-DASH) averaged 23.7 points for decompression patients and 26.2 points for control patients, according to the study.

Univariate analysis showed a significant positive correlation between age and DASH score. There was a significant positive correlation with retraction, reproducibility and fatty degeneration with the work-DASH score. Subscapularis involvement also showed a significant positive correlation with work-DASH score.

Tear retraction showed a significant negative correlation with Constant score, while both tear shape and repair technique were significantly associated with Constant score.

"All other variables, including subacromial decompression, did not show significant correlations with the outcome," the authors said.

"All of the significant associations observed on univariate analysis were confirmed on multivariate analysis; therefore, these variables were considered to be independently associated with the outcome," they said. "Therefore, age, tear pattern and quality of repair significantly affected the results of treatment, regardless of integrity and morphology of the coracoacromial arch."

For more information:
Milano G, Grasso A, Salvatore M, et al. Arthroscopic rotator cuff repair with and without subacromial decompression: A prospective randomized study. Arthroscopy. 2007;23:81-88.