www.thelancet.com Published online November 20, 2017 http://dx.doi.org/10.1016/S0140-6736(17)32457-1
In summary: 3 study groups; physiotherapy only, shoulder arthroscopy, shoulder arthroscopy + acromioplasty. Decent numbers, robust follow up. Both surgical groups did better than physio alone, but no difference between arthroscopy and arthroscopy with acromioplasty.
Just before Christmas, I was at the Geelong Orthopaedic Society annual meeting, and the guest speaker was Prof Andy Carr, from Oxford UK. He was the lead researcher in this really important study, and my old boss in Aberdeen was on the steering committee. We had the chance to discuss the process of the study as well as the results and the response to it. He told us that in less than a week from publication, he had over 700 emails relating to the study, many of them pretty negative, some frankly abusive.
Nobody likes to be told that they are wrong, but the defence of acromioplasty has been predictably vigorous, and largely predictable in its form – everything from “it works in my hands”, to post hoc justifications of why it must work and why this research must be wrong.
This is not entirely new. There was a paper comparing acromioplasty with subacromial bursectomy, from Finland nearly 10 years ago, that showed similar outcomes. The response also mirrors that to the 2002 Moseley study that showed that knee arthroscopy was of no benefit in treatment of OA (see my previous post).
Ultimately, the treatment of shoulder impingement symptoms should focus upon a combination of subacromial steroid injections and good quality physiotherapy to get the cuff muscles working more normally. If that fails, patients do seem to benefit from shoulder arthroscopy and bursectomy, but there is no additional benefit of acromioplasty.
In summary: 3 study groups; physiotherapy only, shoulder arthroscopy, shoulder arthroscopy + acromioplasty. Decent numbers, robust follow up. Both surgical groups did better than physio alone, but no difference between arthroscopy and arthroscopy with acromioplasty.
Just before Christmas, I was at the Geelong Orthopaedic Society annual meeting, and the guest speaker was Prof Andy Carr, from Oxford UK. He was the lead researcher in this really important study, and my old boss in Aberdeen was on the steering committee. We had the chance to discuss the process of the study as well as the results and the response to it. He told us that in less than a week from publication, he had over 700 emails relating to the study, many of them pretty negative, some frankly abusive.
Nobody likes to be told that they are wrong, but the defence of acromioplasty has been predictably vigorous, and largely predictable in its form – everything from “it works in my hands”, to post hoc justifications of why it must work and why this research must be wrong.
This is not entirely new. There was a paper comparing acromioplasty with subacromial bursectomy, from Finland nearly 10 years ago, that showed similar outcomes. The response also mirrors that to the 2002 Moseley study that showed that knee arthroscopy was of no benefit in treatment of OA (see my previous post).
Ultimately, the treatment of shoulder impingement symptoms should focus upon a combination of subacromial steroid injections and good quality physiotherapy to get the cuff muscles working more normally. If that fails, patients do seem to benefit from shoulder arthroscopy and bursectomy, but there is no additional benefit of acromioplasty.
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