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Paavola M, Kanto K, Ranstam J, Malmivaara A, Inkinen J, Kalske J, Savolainen V, Sinisaari I, Taimela S, Järvinen TL. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial. Br J Sports Med 2020; 55:99-107. [PMID: 33020137 PMCID: PMC7788208 DOI: 10.1136/bjsports-2020-102216] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Objectives To assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison). Methods We conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35–65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry. Results In the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −2.0 (95% CI −8.5 to 4.6; p=0.56) at rest and −8.0 (−17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (−5.6 to 7.6; p=0.77) at rest and −3.9 (−12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events. Conclusions ASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.
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Affiliation(s)
- Mika Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Kari Kanto
- TAYS Hatanpää/Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland.,Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | | | - Antti Malmivaara
- Centre for Health and Social Economics - CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Juha Kalske
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Vesa Savolainen
- Department of Orthopaedics and Traumatology, Pohjola Hospital, Helsinki, Finland
| | | | - Simo Taimela
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.,Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
| | - Teppo L Järvinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.,Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
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