Acromioplasty does not reduce the rate of rotator cuff ruptures in shoulder impingement .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(20):13 Acta Orthop. 2016 Aug;87(4):351-5140 patients with shoulder impingement syndrome were randomized to undergo arthroscopic acromioplasty followed by a home-based exercise therapy program, or an exercise therapy program alone. The purpose of this study was to evaluate if there were any significant differences between groups in the incidence of MRI-assessed rotator cuff tear, or muscle volume and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles, over a 5-year follow-up. The results demonstrated no significant difference in any of the listed outcomes.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
1/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
0/4
Therapy Description
2/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
The use of acromioplasty is a contentious issue in the management shoulder impingement syndrome. The most recent evidence has demonstrated little difference in overall outcome in the short-term compared to structured exercise programs. A possible long-term, protective effect of acromioplasty on rotator cuff tendons has been suggested, though this effect has not been previously studied in a randomized controlled trial.
Qual era la domanda di ricerca principale?
In patients with shoulder impingement syndrome, does arthroscopic acromioplasty significantly affect the rate of eventual rotator cuff tear on imaging, or volumes of the rotator cuff muscles, when compared to a structured exercise program alone over a 5-year follow-up?
- Full-thickness rotator cuff tears identified via MRI after 5 years were observed in 8 patients who had undergone arthroscopic acromioplasty and 7 patients who had performed exercise therapy alone.
- There were no significant differences between the arthroscopic acromioplasty group and the exercise therapy group in muscle volume decrease after 5 years, either for the supraspinatus (-7% vs. -4%, respectively; p=0.6), the infraspinatus (p=0.9), or the subscapularis (p=0.5).
- Fatty degeneration of any degree (stages 1-4) was observed in 65% of patients who underwent arthroscopic acromioplasty and 54% of patients who had performed exercise therapy alone (p=0.3).
Che cosa devo ricordare di più?
In the management of patients with grade II shoulder impingement syndrome, there were no significant differences between arthroscopic acromioplasty plus postoperative exercise therapy and exercise therapy alone when considering the development of full-thickness rotator cuff tear or muscle volume & fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles after 5 years.
Come influenzerà l'assistenza ai miei pazienti?
The results of this study suggest that arthroscopic acromioplasty plus home-based exercise therapy does not reduce the rate of rotator cuff ruptures over a 5 year period compared to exercise therapy alone in patients with shoulder impingement syndrome. These results, in combination with data from earlier follow-up, which demonstrated no significant differences between groups in patient-reported symptomatic improvement, suggest that arthroscopic acromioplasty may not be justified in these patients.
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