Short-Term Results of Patients Undergoing Arthroscopic Subacromial Decompression and Acromioplasty

Yıl 2021, Cilt: 11 Sayı: 3, 353 - 357, 20.09.2021

Tacettin Ayanoğlu , Yasin Emre Kaya

https://doi.org/10.33631/duzcesbed.879275

Öz

Aim: The aim of this study is to evaluate the arthroscopic surgery results of cases with isolated subacromial impingement syndrome (SIS) that do not respond to conservative treatment.
Material and Methods: 44 patients who had arthroscopic subacromial decompression and acromiplasty due to SIS between 2015 and 2018, were retrospectively analyzed. Patients with isolated subacromial impingement syndrome who did not respond to conservative treatment including drugs, physiotherapy, exercises and subacromial steroid injections were included. For the patients, preoperative and postoperative The American Shoulder and Elbow Surgeons Shoulder (ASES) Scores were measured.
Results: Forty-four patients with a mean follow-up of 26.4 months (ranging from 24 to 35 months; SD: 7.3) and a mean age of 51.4 (ranging from 39 to 55; SD: 6.96) were reached. Thirty (68%) of the patients were female and fourteen (32%) were male. There were no significant differences between groups according to the age, sex, and follow-up time (p>0.50). There were type 3 acromion in total of 7 patients and type 2 acromion in 18 patients. The overall mean preperative ASES score was 38.8 (ranging from 36.6 to 41.8). And, the mean postoperaive ASES score was 84.9 (ranging from 76.2 to 88.3).
Conclusion: The short-term clinical results of subacromial decompression and acromioplasty in patients who do not respond to conservative treatment has successfull results that support literature knowledge.

Anahtar Kelimeler

Shoulder pain; shoulder impingement syndrome; arthroscopy; operative therapy, Shoulder pain, shoulder impingement syndrome, arthroscopy

Artroskopik Subakromiyal Dekompresyon ve Akromiyoplasti Uygulanan Hastaların Kısa Dönem Sonuçları

Öz

Amaç: Bu çalışmanın amacı, konservatif tedaviye yanıt vermeyen izole subakromiyal sıkışma sendromu (SSS) olan vakaların artroskopik cerrahi sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: 2016-2018 yılları arasında SSS'e bağlı artroskopik subakromiyal dekompresyon ve akromiplasti olan ve düzenli takiplere gelen 44 hasta retrospektif olarak incelendi. NSIAD'ler, fizyoterapi, egzersizler ve subakromiyal steroid enjeksiyonları dahil konservatif tedaviye yanıt vermeyen izole subakromiyal sıkışma sendromlu hastalar dahil edildi. Hastaların ameliyat öncesi ve sonrası Amerikan Omuz ve Dirsek Cerrahları Omuz (ASES) Skorları ölçüldü.
Bulgular: Ortalama takip süresi 2,4 ay (24-35 ay arasında değişen; SS: 7,3) ve yaş ortalaması 51,4 (39-55; SS: 6,96) olan kırk dört hastaya ulaşıldı. Hastaların 30'u (% 68) kadın, 14'ü (% 32) erkekti. Gruplar arasında yaşa, cinsiyete ve takip süresine göre anlamlı fark yoktu (p> 0,50). Toplam 7 hastada tip 3 akromiyon, 18 hastada tip 2 akromiyon vardı. Genel ortalama hazırlayıcı ASES skoru 38,8 idi (36,6 ile 41,8 arasında). Ortalama postoperatif ASES skoru 84,9 idi (76,2 ile 88,3 arasında).
Sonuç: Konservatif tedaviye yanıt vermeyen hastalarda subakromiyal dekompresyon ve akromioplastinin kısa dönem klinik sonuçları literatür bilgisini destekleyen başarılı sonuçlara sahiptir.

Anahtar Kelimeler

Omuz ağrısı, omuz sıkışma sendromu, artroskopi, cerrahi tedavi

Kaynakça

• Roddy E, Zwierska I, Hay EM, Jowett S, Lewis M, Stevenson K, et al. SUPPORT trial team. Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial). BMC Musculoskelet Disord. 2014; 15(1): 81.
• Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972; 54(1): 41-50.
• Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am 1997; 79(12): 1854-68.
• Kanatli U, Ayanoğlu T, Aktaş E, Ataoğlu MB, Özer M, Çetinkaya M. Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. J Shoulder Elbow Surg. 2016; 25(11): 1824-8.
• Bigliani BU, Morrison ES, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986; 10: 216.
• Pappas GP, Blemker SS, Beaulieu CF, McAdams TR, Whalen ST, Gold GE. In vivo anatomy of the Neer and Hawkins sign positions for shoulder impingement. J Shoulder Elbow Surg. 2006; 15(1): 40-9.
• Marwan A, Galvin. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2012; 93: 229-36.
• Roberts CS, Davila JN, Hushek SG, Tillett ED, Corrigan TM. Magnetic resonance imaging analysis of the subacromial space in the impingement sign positions. J Shoulder Elbow Surg. 2002; 11(6): 595-9.
• Liaghat B, Ussing A, Petersen BH, Andersen HK, Barfod KW, Jensen MB, et al. Supervised training compared with no training or self-training in patients with subacromial pain syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2021; 27: S0003-9993(21)00318-X.
• Haahr JP, Ostergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis. 2005; 64(5): 760-4.
• Davis AD, Kakar S, Moros C, Kaye EK, Schepsis AA, Voloshin I: Arthroscopic versus open acromioplasty: A metaanalysis. Am J Sports Med. 2010; 38(3): 613-8.
• Hardy V, Rony L, Bachler J, Favard L, Hubert L. Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res. 2021; 16: 102936.
• Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003; 18(5): 369-79.
• Ma Q, Sun C, Du R, Liu P, Wu S, Zhang W, et al. Morphological characteristics of acromion and acromioclavicular joint in patients with shoulder ımpingement syndrome and related recommendations: A three-dimensional analysis based on multiplanar reconstruction of computed tomography scans. Orthop Surg. 2021; 13(4): 1309-18. https://doi.org/ 10.1111/os.13001.
• Zadro JR, O'Keeffe M, Ferreira GE, Haas R, Harris IA, Buchbinder R, et al. Diagnostic Labels for Rotator Cuff Disease Can Increase People's Perceived Need for Shoulder Surgery: An Online Randomized Controlled Experiment. J Orthop Sports Phys Ther. 2021; 51(8): 401-11.
• Christiansen DH, Hjort J. Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial. J Physiother. 2021; 67(2): 124-31.
• Kim YB, Lee WS, Won JS. The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study. Clin Shoulder Elb. 2021; 24(1): 4-8.
• Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: Temporal outcomes of nonoperative treatment. J Shoulder Elbow Surg 2009; 18(2): 172-7.
• Kuhn JE. Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009; 18(1): 138-60.
• Waterman BR, Newgren J, Gowd AK, Cabarcas B, Lansdown D, Bach BR, et al. Randomized Prospective Trial of Arthroscopic Rotator Cuff with or without Acromioplasty: No Difference in Patient-Reported Outcomes at Long-Term Follow-up. Arthroscopy. 2021; 30: S0749-8063(21)00404-7. https://doi.org/10.1016/j.arthro.2021.04.041
• Davis AD, Kakar S, Moros C, Kaye EK, Schepsis AA, Voloshin I: Arthroscopic versus open acromioplasty: A metaanalysis. Am J Sports Med. 2010; 38(3): 613-8.
• Kappe T, Knappe K, Elsharkawi M, Reichel H, Cakir B. Predictive value of preoperative clinical examination for subacromial decompression in impingement syndrome. Knee Surg Sports Traumatol Arthrosc. 2015; 23(2): 443-8.
• Medancic N, Spanic M, Marinic TB, Klobucar H, Cicak N. Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function. Int Orthop. 2021; 45(4): 1003-7. https://doi.org/10.1007/s00264-020-04930-1.
• Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg Br. 2009; 91(4): 504-10.
• Kolk A, Thomassen BJW, Hund H, de Witte PB, Henkus HE, Wassenaar WG, et al. Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years' follow-up. J Shoulder Elbow Surg. 2017; 26(8): 1407-15.
• Kukkonen J, Ryösa A, Joukainen A, Lehtinen J, Kauko T, Mattila K, et al. Operative vs. conservative treatment of small non-traumatic supraspinatus tears in patients over 55 years: Over 5-year follow-up of a randomized contralled trial. J Shoulder Elbow Surg. 2021; 24: S1058-2746(21)00330-X. https://doi.org/ 10.1016/j.jse.2021.03.133.