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Saturday, March 13, 2004

Open acromioplasty relieves pain, improves function

By Mary Ann Porucznik

Open acromioplasty as a treatment for impingement syndrome is a durable procedure that can provide long lasting pain relief and improved function, said the authors of Scientific Paper 212 on Friday. Their long-term follow-up study found that no participants reported severe pain and that there was no statistical difference between pain in the operated and nonoperated shoulders.

Between 1975 and 1979, 65 patients (66 involved shoulders) had anterior acromioplasty to treat rotator cuff tears or tendonitis. An initial report on patient satisfaction and function was conducted among these patients in 1990. Subsequently, at a mean follow-up of 24 years, the hospital's Institutional Review Board reopened the study to determine long-term satisfaction.

Although 25 of the original 65 patients were deceased, 35 out of the remaining 40 patients (36 shoulders) agreed to participate. All 36 shoulders had been diagnosed with impingement syndrome. Minimum follow-up was 21 years. Each patient completed a detailed shoulder questionnaire survey and researchers reviewed the clinical records for each patient.

Researchers found that at the latest follow-up, patients had a mean elevation of 168 in the operated shoulder, versus 171 in the nonoperated shoulder (p > 0.10). The mean external rotation was 70.3 on the operated side and 69.3 on the non-operated side (p > 0.10). There was little change since 1990, when the mean forward elevation was reported at 167 and the external rotation at 64.

Using a scale of 1 to 10 (poor to excellent), the patients surveyed reported an average preoperative satisfaction of 2.3 and an average postoperative satisfaction of 7.0. The mean score on the American Shoulder and Elbow Surgeons (ASES) test was 74.7 on the operated side and 83.3 on the non-operated side (p < 0.05). Only 3 of 35 shoulders (8.6 percent) had a second operation since the last follow-up.

"To our knowledge, there has been no other study published in the English orthopaedic literature with this length of follow-up," said the authors. "The data from this study suggest that the results of open acromioplasty are maintained up to a 20-year period. It is a durable procedure that can provide long-lasting pain relief and improved function with a relatively low rate of re-operation."

Authors included: Patrick Chin, MD, of Nanaimo, BC Canada; and John William Sperling, MD, and Robert H. Cofield, MD, both of Rochester, Minn.

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Last modified 20/February/2004