Year: 2016  Study type: RCT  

Ketola S. Shoulder Impingement Syndrome - Arthroscopic acromioplasty offers no additional benefits compared to structured exercise treatment. University of Tampere. Doctoral Dissertation; 2016.

Objective

To study the efficacy and cost-effectiveness of arthroscopic acromioplasty in the treatment of Stage II shoulder impingement syndrome.

Methods

Randomized controlled trial, n=140 (52 men, 88 women), 18-60 years of age.

Supervised exercise treatment group (n=70). Combined treatment group (n=70): arthroscopic acromioplasty followed by a similar exercise programme as in exercise treatment group.

Main outcome measures: Self-reported pain (VAS-scale) measured at baseline and 2 years (n=134) and 5 years (n=109) after randomization

Outcome

2-year follow-up: statistically significant decrease in pain (p<0.001) was observed in both treatment groups (exercise group 6.5 → 9, combined group 6.4 → 2.5). No statistical difference between the groups (p=0.65). No difference in number of pain-free patients. The combined treatment was more costly.

5-year follow-up: There was further improvements in pain between two and five-year follow-up. Exercise group: 2.9 → 2 and combined group 2.5 → 1.9. The proportion of pain-free patients increased to 77% (exercise group) and 73% (combined group), no difference between groups (p = 0.86).

Conclusion: Acromioplasty does not seem to be a cost-effective treatment method. Structured exercise treatment should be the primary treatment for shoulder impingement syndrome.