Objectives. To report the five-year results of a randomised controlled trial
examining the effectiveness of arthroscopic acromioplasty in the
treatment of stage II shoulder impingement syndrome. Methods. A total of 140 patients were randomly divided into two groups:
1) supervised exercise programme (n = 70, exercise group); and 2)
arthroscopic acromioplasty followed by a similar exercise programme
(n = 70, combined treatment group). Results. The main outcome measure was self-reported pain as measured on
a visual analogue scale. At the five-year assessment a total of
109 patients were examined (52 in the exercise group and 57 in the
combined treatment group). There was a significant decrease in mean
self-reported pain on the VAS between baseline and the five-year follow-up
in both the exercise group (from 6.5 (1 to 10) to 2.2 (0 to 8);
p <
0.001) and the combined treatment group (from 6.4 (2 to 10)
to 1.9 (0 to 8); p <
0.001). The same trend was seen in the secondary
outcome measures (disability, working ability, pain at night, Shoulder
Disability Questionnaire and reported painful days). An intention-to-treat
analysis showed statistically significant improvements in both groups
at five years compared with baseline. Further, improvement continued
between the two- and five-year timepoints. No statistically significant differences
were found in the patient-centred primary and secondary parameters
between the two treatment groups. Conclusions. Differences in the patient-centred primary and secondary parameters
between the two treatment groups were not statistically significant,
suggesting that acromioplasty is not cost-effective. Structured
exercise treatment seems to be the treatment of choice for shoulder
impingement syndrome
