Does Acromioplasty Improve Long-Term Outcomes of Rotator Cuff Repair?
In 2011, researchers from Canada reported that after 24 months of follow-up, they found no difference in functional or quality-of-life indices in a cohort of 86 patients with full-thickness rotator cuff tears who had been randomized to undergo rotator cuff repair with or without acromioplasty. [1]
At that time point, 4 patients (9%) in the no acromioplasty group required reoperation due to persistent symptoms (1 with a type-II acromion and 3 with type-III acromion), while no patients in the acromioplasty group had follow-up surgery.
The researchers recommended further study with a longer follow-up period to determine if these findings would hold.
At the American Orthopaedic Society for Sports Medicine’s Annual Meeting 2022, the researchers provided an answer: Eleven years after surgery, they still saw little difference in outcomes between the 2 groups.
Study Methodology
Recruitment for the original study was conducted between June 2003 and February 2009, with a 24-month follow-up occurring between 2005 and 2011.
This secondary study was conducted between April 2015 and March 2021, with the goal of determining “the long-term efficacy of performing a subacromial decompression in cases of full-thickness rotator cuff tears,” according to study author Jarret Woodmass, MD, from the Pan Am Clinic in Winnipeg, Manitoba, Canada.
Patients from the original study were invited by a blinded assessor to return for a follow-up visit involving the same methodology as their previous visits. This included clinical assessment and completion of a patient-reported outcome, the Western Ontario Rotator Cuff score (WORC).
Of the 86 patients in the original trial, 57 completed the long-term follow-up, 31 of 45 from the no acromioplasty group, and 25 of 41 from the acromioplasty group:
- 61% in the no acromioplasty group and 64% in the acromioplasty group were male
- Mean (SD) duration of follow-up was 11.2 years (2.4) for the no acromioplasty group and 11.5 years (2.6) for the acromioplasty group
- Mean (SD) age of patients at the time of initial surgery for the no acromioplasty group was 58.5 years (8.4) and 56.2 years (7.8) for the acromioplasty group
- Mean age at most recent follow-up was 69.0 years (9.3) for the no acromioplasty group and 67.7 years (7.7) for the acromioplasty group
Study Findings
No significant difference in WORC was observed between the no acromioplasty and acromioplasty groups at the time of long-term follow-up (P=0.30). The WORC score continued to be significantly improved from preoperative scores in both groups (P<0.001). In the initial study, 4 patients in the no acromioplasty group had undergone revision surgery at 24 months after the initial procedure. Of those, 2 returned for long-term follow-up and 2 did not.
In long-term follow-up, another 6 patients in the no acromioplasty group had undergone additional surgery on their study shoulder since the 24-month follow-up, including 3 rotator cuff revisions, 1 total shoulder arthroplasty, and 2 unknown shoulder surgeries (patient-reported surgeries), for a total of 10 in that group. Only 1 participant in the acromioplasty group had undergone revision shoulder surgery.
“Both groups maintained improved outcomes from their preoperative status,” Dr. Woodmass said. “However, the revision rate was significantly higher in those that did not undergo acromioplasty at the time of their initial surgery.”
Source
Woodmass J, et al. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears: Long Term Follow-up of a Multicenter, Randomized Controlled Trial (Paper 65). Presented at the American Orthopaedic Society of Sports Medicine’s Annual Meeting 2022, July 13-17, 2022, Colorado Springs, Colorado.
Reference
- MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: a multicenter, randomized controlled trial. J Bone Joint Surg Am. 2011 Nov 2;93(21):1953-60. doi: 10.2106/JBJS.K.00488.