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Study: Long-term acromioplasty results no better than structured exercise for anterolateral shoulder pain

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BARCELONA — Among 140 patients randomized to undergo either supervised exercise alone or a combination treatment for anterolateral shoulder pain that involved supervised exercise with arthroscopic acromioplasty surgery, both groups obtained statistically significant changes compared to baseline through 12-year follow-up, but investigators found no significant difference between the results for the groups.

“Considering that the strong placebo effect of surgery did not make the operated patients feel better than controls, one could even suspect that the true effect of surgery is negative,” Saara Ketola, MD, PhD, said at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress.

To be included in the prospective randomized study, patients could not have had any previous shoulder surgery and their pain had to be resistant to earlier attempts to resolve it. The groups were similar at randomization, according to Ketola.

Saara Ketola

“The exercise program was similar in both groups. The only difference being, then, the operation,” she said.

Self-reported pain was the primary clinical outcome used in the study, and patients were followed up long-term via questionnaires for a mean of 12 years.

The change in pain from baseline through 10 years was -4.5 and -3.6 for the exercise and combination groups, respectively, which was highly significant for both groups, according to Ketola.

“The additional effect of acromioplasty does not seem to be significant nor cost-effective,” she said, citing the increased costs of the surgery, lost ability to work and risk of complications.

“The indications for arthroscopic acromioplasty should be redefined. Structured exercise treatment should be the treatment of choice. Based on our results, we do not recommend an arthroscopic acromioplasty in the treatment of shoulder impingement syndrome for working-age patients,” Ketola said. – by Susan M. Rapp

Reference:

Ketola S, et al. Paper #FP16-6177. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.

Disclosure: Ketola reports no relevant financial disclosures.