Regarding “Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons”

Abstract

We read with great interest the study by Hohmann et al.,1 “Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons.” Undoubtedly, the management of patients with subacromial impingement (SI) is still controversial, expressed in this study by the fact that consensus could only be reached for 22% of the 71 Likert style items included.We wish to congratulate the authors for the enormous effort involved in carrying out this consensus, and we would like to raise a few observations about the interpretation of the study results and the role of subacromial decompression (SAD) in patients with SI.In 2009, Ketola et al.2 performed a randomized controlled trial (RCT) including 134 patients in which they compared a supervised exercise program (n = 66) with arthroscopic acromioplasty followed by a supervised exercise program (n = 68). No statistically significant difference was found neither in relation to the visual analog scale score nor in the secondary outcomes considered, which were pain at night, disability, shoulder disability questionnaire score, number of days experiencing pain, and number of patients without pain. In a similar study, Farfaras et al.3 randomized 55 patients with SI into open acromioplasty (n = 15), arthroscopic acromioplasty (n = 19), or physiotherapy (n = 21) treatment, and the authors also found no significant differences between the 3 groups in a period up to 3 years after the intervention.3 Some recent RCTs were performed, including a placebo surgery control group.4,5