Revision surgery after failed subacromial decompression

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Scoping Review of Psychological and Psychosocial Constructs and Outcome Measures Reported in Tendinopathy Clinical Trials

OBJECTIVE

To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research.

DESIGN

Scoping review.

LITERATURE SEARCH

We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors.

STUDY SELECTION

Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation.

DATA SYNTHESIS

We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field.

RESULTS

Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were work-related outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct.

CONCLUSION

There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. J Orthop Sports Phys Ther 2022;52(6):375-388. doi:10.2519/jospt.2022.11005.

Predictive value of preoperative clinical examination for subacromial decompression in impingement syndrome

PURPOSE

Subacromial decompression is the standard surgical treatment of subacromial impingement syndrome. Unsatisfactory results have been reported for concomitant lesions as well as inadequate diagnosis. We sought to determine the predictive value of the preoperative examination for the results of arthroscopic subacromial decompression in impingement syndrome.

METHODS

Forty-nine shoulder joints in 47 patients receiving arthroscopic subacromial decompression were prospectively followed for a mean 3.7 ± 0.4 years. Prior to surgery, the impingement tests according to Neer, Hawkins-Kennedy (in the neutral as well as abducted position), and the Jobe test (empty can position) were evaluated as well as the presence of a painful arc. The association between the presence of these sings, success of the operation, and improvement in Constant scores as well as WORC indices was analysed.

RESULTS

Pre- to postoperative improvement in Constant scores as well as WORC indices was greater in case of a positive test result for every test studied. With the numbers available, significant greater improvements in Constant scores were observed only for patients with a positive Hawkins-Kennedy sign in the neutral position, Neer and Jobe tests, compared to patients with negative signs, respectively. No significant differences were observed for the improvement in WORC indices. Patients with at least four positive tests out of the five studied had greater improvement in Constant scores than patients with three or less positive test results. Five patients went on to receive subsequent shoulder surgery. There was no association between the necessity for revision surgery and the presence or absence of impingement signs.

CONCLUSION

The impingement tests according to Hawkins-Kennedy, Neer, and Jobe are valid predictors of outcome after subacromial decompression, as is the presence of multiple impingement tests. This study may aid in improving patient outcome and especially patient selection for subacromial decompression.

LEVEL OF EVIDENCE

Prognostic, Level I.

Failed subacromial decompression. Risk factors

BACKGROUND

Arthroscopic subacromial decompression (acromioplasty) is widely held to be effective, although pain may persist after the procedure. The objective of this study was to evaluate the proportion of patients with residual pain (i.e., the failure rate) after isolated subacromial decompression and to look for predictors of failure.

MATERIAL AND METHOD

We conducted a retrospective multicentre study of 108 patients managed with isolated arthroscopic subacromial decompression between 2007 and 2011, for any reason. We excluded patients in whom surgical procedures on the rotator cuff tendons were performed concomitantly. Data were collected from the medical records, a telephone questionnaire, and radiographs obtained before surgery and at last follow-up. Failure was defined as persistent pain (visual analogue scale score>3) more than 6 months after surgery and at last follow-up.

RESULTS

The failure rate was 29% (31/108). Two factors significantly predicted failure, namely, receiving workers' compensation benefits for the shoulder condition and co-planing. Heterogeneous calcific tendinopathy and deep partial-thickness rotator cuff tears were also associated with poorer outcomes, but the effect was not statistically significant.

DISCUSSION

Co-planing may predict failure of subacromial decompression, although whether this effect is due to an insufficient degree of co-planing or to the technique itself is unclear. Nevertheless, in patients with symptoms from the acromio-clavicular joint, acromio-clavicular resection is probably the best option. Receiving workers' compensation benefits was also associated with treatment failure, as a result of well-known parameters related to the social welfare system.

CONCLUSION

Isolated arthroscopic subacromial decompression is effective in 70% of cases. We recommend the utmost caution if co-planing is considered and/or the patient receives workers' compensation benefits for the shoulder condition, as these two factors are associated with a significant increase in the failure rate.

LEVEL OF EVIDENCE

IV (retrospective study).

Outcomes of open subacromial decompression after failed arthroscopic acromioplasty

Aim. To prospectively assess the effectiveness of revision with open subacromial decompression in patients who had a previous unsatisfactory outcome with the arthroscopic procedure. Methods. 11 patients were identified for the study, who did not demonstrate expected improvement in symptoms after arthroscopic acromioplasty. All patients underwent structured rehabilitation. Functional evaluation was conducted using the Hospital for Special Surgery, New York, shoulder rating questionnaire. Results. M : F was 7 : 4. The mean age was 57 years. The average shoulder score improved from 49.6 preoperatively to 56 postoperatively at an average followup of 16 months. Two patients showed deterioration in their shoulder scores after revision while the rest showed only marginal improvement. All except one patient stated that they would opt for surgery again if given a second chance. Conclusion. In the group of patients that fail to benefit from the arthroscopic decompression, only a marginal improvement was noted after revision with open decompression.

Difference in outcome of shoulder surgery between workers' compensation and nonworkers' compensation populations

The purpose of this study was to review the association between compensation status and surgical outcome especially of the shoulder. Given the high prevalence of shoulder injuries in the workplace and the large proportion of workers compensation (WC) claims involving such injuries, it is worth examining the correlation between WC status and surgical outcome of the shoulder. All studies published in journals (MEDLINE and PubMed) from 1980 through 2007 on surgical interventions performed on the shoulder in which workers compensation status was documented and the postoperative functional outcome was compared according to that status were pooled for meta-analysis. This systematic review shows that compensation status of an individual receiving shoulder surgery is a consistent positive predictor of poor functional outcome. The majority of questions posed in the most commonly adopted shoulder-specific functional outcome measurement tools were subjective in nature and may account for part of the phenomenon.