Subacromial decompression has little impact on rotator cuff repair outcome

Analyses confirm that subacromial decompression is not linked to outcome.

HOLLYWOOD, Fla. — Italian researchers recently confirmed that subacromial decompression has no significant clinical effect when performed with full-thickness rotator cuff repair.

In a randomized 80-patient clinical trial, they found no difference between patients treated with arthroscopic rotator cuff repair and subacromial decompression and patients treated with only arthroscopic rotator cuff repair. "Subacromial decompression was not significantly associated with the outcome [scores] considered in this study," said Giuseppe Milano, MD, of Catholic University of the Sacred Heart in Rome.

He and his colleagues further performed univariate and multivariate analyses (P<.05) to find independent variables that were related to outcome.

They associated tear shape, tear retraction and repair technique independently to objective outcome, while age, tear retraction, reducibility, fatty degeneration and extension of the tear to the subscapularis were independently associated to subjective outcome, Milano said at the Arthroscopy Association of North America 25th Annual Meeting.

Researchers randomly assigned 40 patients to each of two treatment groups. Patients in Group 1 underwent arthroscopic rotator cuff repair with subacromial decompression and release of the coracoacromial ligament, while patients in Group 2 underwent arthroscopic rotator cuff repair alone.

They excluded any patients with Type I acromion, os acromiale, partial-thickness tears, irreparable tears, labral tears, glenohumeral and acromion-clavicular joint osteoarthritis, previous surgery and workers' compensation.

At two-year follow-up, researchers evaluated patients using the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire and the Constant score. Nine patients (11.2%), including three in Group 1 and six in Group 2, were lost to follow-up.

Milano and colleagues evaluated the following independent variables: age, gender, dominance, tear location and retraction (Patte's classification), tear shape and area, reducibility, fatty degeneration (Fuchs' classification), long head of the biceps treatment, extension of the tear to the subscapularis, repair technique, acromion type (Type 2 or Type 3) and whether the patient underwent subacromial decompression.

"The two groups were no different for all of the variables considered," Milano said. "The univariate analysis showed that the following variables were not significantly associated with the outcome: gender, dominance, tear rotation, area, biceps treatment and the type of acromion."

The researchers found, however, that age was significantly correlated with the DASH score and tear shape was significantly related to the Constant score. "Crescent-shaped tears showed a better result, and the U-shaped tears showed the worst results," he said.

Tear retraction was significantly related to both the Constant score and the Work-DASH score.

Tear reducibility, the degree of fatty degeneration and the extension of the tear to the subscapularis were also significantly related to the Work-DASH score, Milano said.

On the other hand, "The repair technique was significantly correlated with the Constant score, which showed better results for suture anchor repair and the worst results for side-to-side and combined repair," Milano said.

Multivariate analysis confirmed that variables significantly related to the outcome were also independently related to the outcome. Further, multivariate analysis confirmed that, "Subacromial decompression did not affect the clinical outcome of arthroscopic repair of full-thickness rotator cuff tears, despite the acromial morphology at a short-term follow-up," Milano said.

For more information:
Milano G, Grasso A, Deriu L, et al. The role of subacromial decompression associated with arthroscopic rotator cuff repair: A prospective randomized study. #SS-32. Presented at the Arthroscopy Association of North America 25th Annual Meeting. May 18-21, 2006. Hollywood, Fla.